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Abdominal Aortic Aneurysm (AAA) Screening

Discussion in 'I care for a person with dementia' started by canary, Jul 15, 2019.

  1. canary

    canary Registered User

    Feb 25, 2014
    10,531
    Female
    South coast
    OH does not yet have a diagnosis, but there is no doubt in my mind that he is in cognitive decline.
    He passes the MMSE, but has problems with long-term memory; has language difficulties; can no longer problem solve and has made some horrendous decisions; has lost most of the tasks he was once able to perform so that he can no longer make himself a meal (not even a microwave one) although he can still make himself a sandwich and coffee; he requires my help in showering and catheterising and no longer shaves; his mobility is reducing so that he needs a rollator; he sometimes coughs and chokes when eating so that I have changed to a somewhat softer diet like shepherds pie or curry with rice.

    In the midst of this OH has received an appointment for ultrasound check for AAA. I didnt know much about this, so I have googled it and it seems that the only treatment is complex surgery to graft a repair on the blood vessel wall to strengthen it - if the aneurysm is very large.

    My gut reaction is to cancel this screening appointment as I dont think surgery would be a good thing to do, so why worry about whether he has this or not? He also has lots of other appointments at the moment and we are both rather stressed. He also doesnt seem to have any of the risk factors (never smoked, doesnt have high blood pressure, no family history etc)

    What are your thoughts?
     
  2. nita

    nita Registered User

    Dec 30, 2011
    1,802
    Female
    Essex
    Personally, I'd speak to the GP about this and get his view. He'll probably concur with you that it would be unnecessary and possibly distressing to your OH. Why has this appointment come up - is it a follow-up to something the GP found?
     
  3. Sirena

    Sirena Registered User

    Feb 27, 2018
    1,647
    Female
    In your position I'd cancel.
    My FIL had an AAA which was discovered when they were scanning him for something else. He was in his mid 70s and fairly healthy (heart attack about 15 years earlier, no cognitive or mobility problems). He had the surgery and it was a really major deal. He had post-operative renal failure, which is not uncommon, and it took him months to fully recover. I think it would be too much for someone with already failing mental and physical health. If they do find anything wrong, it will just give you extra stress. That's how I'd see it anyway.
     
  4. canary

    canary Registered User

    Feb 25, 2014
    10,531
    Female
    South coast
    No, its a routine screen in this area. They offer it to all men coming up to 65yrs as the chances of an AAA increase at this point. (OH is actually 63, so they are being very keen)

    @Sirena - thats pretty much how I feel
     
  5. nita

    nita Registered User

    Dec 30, 2011
    1,802
    Female
    Essex
    In that case, I'd definitely agree, not go. Interestingly, my brother is 64 and he's not been offered that in this area.
     
  6. canary

    canary Registered User

    Feb 25, 2014
    10,531
    Female
    South coast
    I think it varies in different locations @nita
    Ive not heard of it being offered anywhere else. We also get offered screening for bowel cancer along with the usual cervix and mammogram (for me) and prostate cancer (for him). I guess our area is super keen on screening tests
     
  7. Lawson58

    Lawson58 Registered User

    First thoughts: Your husband is quite young comparatively speaking but obviously has multiple health problems. Big decision to be made.

    Second thoughts: My husband turns 80 later this year. He had a diagnosis of AD five years ago and we have noted before a lot of similarities between your husband and mine as to long term memory, problem solving deficits etc. OH also has heart failure and has a defibrillator but has also been on blood thinning medication for years. This medication of course complicates any surgery.

    He used to see a cardiologist quite regularly and an echocardiogram found that he has a widening of the aorta that at the time it was considered he would require an operation of some kind further down the track. The cardiologist thinks that he can no longer do anything much for my husband and that he now needs good management and regular checks of his defibrillator. This has been appropriate as we have an excellent GP.

    Since his cardiac arrest, my husband has had an internal bleed that apparently was coming from within his stomach. Surgery was discussed but 3-4 hours of surgery appeared to be too risky and as it hasn't happened again it was a good decIsion.

    Third thought: As my OH hasn't had another echocardiogram, I have no idea of what has happened with the widening of the aorta and I don't want to know.

    I think that some of the options these days are nowhere as invasive as they used to be and I think sometimes they fit stents to circumnavigate the nasty bit before things reach crisis point.

    I think before you decide to cancel the appointment that you have a chat with your GP about what might be involved in any treatment if it is required. It may not be as big an issue as you fear and and could be worth some consideration.

    Let us know what you decide.
     
  8. Philbo

    Philbo Registered User

    Feb 28, 2017
    687
    Male
    Kent
    I had my AAA screening here in East Kent just before I was 65 - the leaflet explained that all men would be invited in the year of their 65th birthday, so I was actually 64 (birthday in December) and mine was thankfully "normal".

    My wife (PWD) no longer goes for her breast screening or diabetic eye screening, as she can't follow instructions, hold still long enough or answer question.
     
  9. Jaded'n'faded

    Jaded'n'faded Registered User

    Jan 23, 2019
    471
    Female
    High Peak
    The cynic in me speaking: don't they get paid for every screening test they do?
     
  10. Palerider

    Palerider Registered User

    Aug 9, 2015
    701
    Male
    North West
    Hi Canary,

    If you've googled AAA then you'll be aware of the risks of AAA. Screening is a national program as part of the wider mission to be proactive rather than reactive on health problems that are known to be common. and treatable with good outcomes if caught early.

    The problem with dementia arises in whether it would worthwhile putting someone through corrective surgery if the risks outwiegh the benefit. But that would depend on a number of factors not just dementia.

    It all depends on what your OH wishes would be and what you yourself think he would want and how he is in general health. No harm in discussing it with the GP and weighing up the pros and cons
     
  11. Bunpoots

    Bunpoots Registered User

    Apr 1, 2016
    3,023
    Nottinghamshire
    I think I’d cancel. You’ve got more than enough stress to be going on with and I too wonder how your OH would deal with surgery and what problems that might cause.
     
  12. Lawson58

    Lawson58 Registered User

    Canary, I think we now find ourselves in a slightly similar situation but at this stage we don't have to make a decision about anything.

    OH has had mild anaemia for quite a long time and has been regularly tested and medicated. This was because he had an internal bleed several years ago. One of the problems with taking iron tablets is that it is difficult to know if there is a tiny bleed anywhere.

    So he had a regular blood test last week and saw GP this morning. The upshot is that GP wants him to have another blood test in a month and then consider the possibility of a colonoscopy to rule out a few possible problems. I was at the pharmacy and for the first time wasn't present during the consultation. But our GP (bless him) wrote notes for me!

    I said to OH that I wondered what they would do if they found something, not convinced they would operate. He replied that he would do as he was told (ha ha ha) because GP knows best.

    I think in view of his age, 80 this year, his AD and his heart failure that I am not inclined to go ahead with it but I might have to do some fancy footwork to avoid it. He is so afraid of dying that he would do anything.

    So now we wait and see. I might have to have a little visit with our GP between now and then.
     

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