boltnut55
01-03-2004, 03:38 AM
Hi. My father is almost 90 and two weeks ago was diagnosed w/CHF when he ended up in the ER w/breathing problems. Several days later, he was released (W/O proper meds, which we took care of the next day), but yesterday morning, he ended up in the ER again. This time, the drs. found out he had a small heart attack. Drs. did an angiogram today and found that all three arteries were damaged/clogged (not sure of term). When I asked how much, one dr. said all were 65-90% bad. They didn't do an angioplasty but would have the heart surgeon/team evaluate him over the weekend (he's in a teaching hospital).
Besides cataract/glaucoma and hearing problems, he does have high blood pressure ("normally" 170'ish) and high cholesterol (no idea of numbers). Other than that, he is able to live alone, cook, clean, and bathe... well, until this whole CHF episode, of course.
Is 90 too old to have bypass surgery? I guess I'm trying to figure out if it's automatically a bad idea or whether there should be consideration to his current quality of life, etc. My normal way of handling these situation is to tell him the positive and negative and say, "Dad, you need to decide!" When I explained the angiogram to him, I did tell him there's a chance that they can't do the angioplasty and he might have to have bypass surgery. He said he would agree to the bypass surgery too, but when the drs. told me about the three clogged arteries, one mentioned that the surgical team would still have to evaluate him to see if he's a candidate (as in just cuz dad's willing doesn't mean it'll get done).
If he doesn't get it done, they would do the angioplasty as a backup way and hope it'll take care of the problem. My dad has said that he doesn't need to live to 100. If he can get a few more good years, he'll be happy (always the optimist... not sure why he got me as a pessimistic child!).
Any comments? Answers? HELP!
Besides cataract/glaucoma and hearing problems, he does have high blood pressure ("normally" 170'ish) and high cholesterol (no idea of numbers). Other than that, he is able to live alone, cook, clean, and bathe... well, until this whole CHF episode, of course.
Is 90 too old to have bypass surgery? I guess I'm trying to figure out if it's automatically a bad idea or whether there should be consideration to his current quality of life, etc. My normal way of handling these situation is to tell him the positive and negative and say, "Dad, you need to decide!" When I explained the angiogram to him, I did tell him there's a chance that they can't do the angioplasty and he might have to have bypass surgery. He said he would agree to the bypass surgery too, but when the drs. told me about the three clogged arteries, one mentioned that the surgical team would still have to evaluate him to see if he's a candidate (as in just cuz dad's willing doesn't mean it'll get done).
If he doesn't get it done, they would do the angioplasty as a backup way and hope it'll take care of the problem. My dad has said that he doesn't need to live to 100. If he can get a few more good years, he'll be happy (always the optimist... not sure why he got me as a pessimistic child!).
Any comments? Answers? HELP!
Sponsor
zip2play
01-03-2004, 09:41 AM
boltnut,
What I would do in his position. I'd have the angioplasty with stent if possible on one, two or three of the arteries...but if one or more couldn't be ballooned, I'd leave it alone and opt for drugs like channel blockers or beta blockade.
Age 90 is TOO OLD to have a chest cracked open and heart lung-machine torment and long intensive care. I think the bypasses would shorten his life-span.
I honestly think the surgical team wouldn't (or shouldn't) even consider the bypass procedure....odds are too high he'd never make it off the table!
What I would do in his position. I'd have the angioplasty with stent if possible on one, two or three of the arteries...but if one or more couldn't be ballooned, I'd leave it alone and opt for drugs like channel blockers or beta blockade.
Age 90 is TOO OLD to have a chest cracked open and heart lung-machine torment and long intensive care. I think the bypasses would shorten his life-span.
I honestly think the surgical team wouldn't (or shouldn't) even consider the bypass procedure....odds are too high he'd never make it off the table!
boltnut55
01-04-2004, 04:19 AM
Thanks. It turns out that 6 arteries are blocked, all between 60% - 90% blocked. The surgical team is going to look at him by Monday and determine if he is a candidate. If not, they will do the angioplasty wherever they can.
The doctor (well, intern anyway) said that his age is not necessarily an eliminating factor (yikes!) because he's a strong, sturdy patient (my dad speaks loudly, so he comes across that way, along w/being opinionated!), but we'll know more by Monday, I guess.
Love to hear other comments as well.
Rose
The doctor (well, intern anyway) said that his age is not necessarily an eliminating factor (yikes!) because he's a strong, sturdy patient (my dad speaks loudly, so he comes across that way, along w/being opinionated!), but we'll know more by Monday, I guess.
Love to hear other comments as well.
Rose
Belle2003
01-07-2004, 12:16 AM
I have heard of elderly people having a bypass done and they end up not making it through the operation. It was like the doctor just wanted to make some money from the surgery knowing that the odds were not good that the patient would survive. Plus the elderly take longer to heal and recover. It is harder for them to fight off infection too.
If the doctor gives your father a choice between the operation and the angiplasty, I would go for the angiplasty. Plus I would ask what the survival rate is on both procedures for a man of his age. Then I would ask how long would the angiplasty last.
My brother in law's father went in for a heart bypass and never woke up. He was only 79.
Ask what your father's options are, including medication options.
If the doctor gives your father a choice between the operation and the angiplasty, I would go for the angiplasty. Plus I would ask what the survival rate is on both procedures for a man of his age. Then I would ask how long would the angiplasty last.
My brother in law's father went in for a heart bypass and never woke up. He was only 79.
Ask what your father's options are, including medication options.
crabbycdn
01-09-2004, 11:58 PM
Surgery of any kind presents risks to elderly patients. This is a very invasive procedure with major risks. Your father must have gold-plated health insurance!
boltnut55
01-10-2004, 03:42 AM
Thank you everyone for your insight. The doctor evaluated him and gave him three choices: (1) bypass, although they weren't thrilled about this choice; (2) angioplasty on two or three of the arteries; and (3) medication only. There is at least one major artery that can't be fixed at all no matter what he chose because of its location, so the heart attack from that artery was probable. After I gave my dad his three choices w/the pros and cons, he chose medication only.
Initially, he had said okay to bypass (I was worried that something bad would happen during the angiogram in which I had to make a decision, so we discussed this), but after a better discussion w/the attending physician, I found out that it would be a one-year recovery period... for a 90 year old, that one year could be crucial, so I had hoped he didn't choose that. I was a little surprised he didn't choose the angioplasty, since he's sort of an aggressive guy, but it was considered high risk; there was a chance that it would have to be redone w/i 6 months; and there was still a possibility that he would have a heart attack because of the other arteries being blocked.
Regarding insurance, he has Medicare which would pay for the hospital stay, and there was some likelihood that his veteran's benefits would pay for the other stuff (he normally goes to the VA hospital, but this time was taken to UCSF, a teaching hospital).
Thanks again for all your help. I may need to check in later in case something else goes on regarding his heart.
Initially, he had said okay to bypass (I was worried that something bad would happen during the angiogram in which I had to make a decision, so we discussed this), but after a better discussion w/the attending physician, I found out that it would be a one-year recovery period... for a 90 year old, that one year could be crucial, so I had hoped he didn't choose that. I was a little surprised he didn't choose the angioplasty, since he's sort of an aggressive guy, but it was considered high risk; there was a chance that it would have to be redone w/i 6 months; and there was still a possibility that he would have a heart attack because of the other arteries being blocked.
Regarding insurance, he has Medicare which would pay for the hospital stay, and there was some likelihood that his veteran's benefits would pay for the other stuff (he normally goes to the VA hospital, but this time was taken to UCSF, a teaching hospital).
Thanks again for all your help. I may need to check in later in case something else goes on regarding his heart.
Gatormom
03-20-2004, 06:32 AM
[QUOTE=crabbycdn]Surgery of any kind presents risks to elderly patients.
This is an older thread but I just wanted to add a post - - my mother had open heart surgery (replacing aortic valve and 4" of aorta) at the age of 83. She is now 86 and although she still has atrial fibrillation, her quality of life has continued to be about the same, whereas the docs all said she had 6 months or less to live without the surgery. Yes it was a long ordeal, especially overcoming the effects of anesthesia, but we still have her. It was her informed decision to go ahead and do it, knowing the risks. When deciding whether she was a good candidate for the operation, her doctor asked her what she wanted to be able to do in the future, and she answered "travel, swim, take walks, etc" - - he said those goals made a difference to him versus an 83 yr old hoping to sit in a chair, read, etc. She has indeed been able to swim, take walks and limited trips, although diabetes now is taking a toll on her systems. You can't go back and make those decisions (Monday morning quarterbacking) but what I know for sure is, there's no ONE right or wrong answer when looking at major surgery for elderly folks. It depends on so many factors for each individual. Personally, I'm glad we still have Mom.
This is an older thread but I just wanted to add a post - - my mother had open heart surgery (replacing aortic valve and 4" of aorta) at the age of 83. She is now 86 and although she still has atrial fibrillation, her quality of life has continued to be about the same, whereas the docs all said she had 6 months or less to live without the surgery. Yes it was a long ordeal, especially overcoming the effects of anesthesia, but we still have her. It was her informed decision to go ahead and do it, knowing the risks. When deciding whether she was a good candidate for the operation, her doctor asked her what she wanted to be able to do in the future, and she answered "travel, swim, take walks, etc" - - he said those goals made a difference to him versus an 83 yr old hoping to sit in a chair, read, etc. She has indeed been able to swim, take walks and limited trips, although diabetes now is taking a toll on her systems. You can't go back and make those decisions (Monday morning quarterbacking) but what I know for sure is, there's no ONE right or wrong answer when looking at major surgery for elderly folks. It depends on so many factors for each individual. Personally, I'm glad we still have Mom.
boltnut55
03-20-2004, 09:09 PM
Well, here's an update, and hopefully what happened to him is NOT the norm! He ended up in the hospital again, and this time he decided to go ahead w/the angioplasty (done on 1/23). Three stents were put in, he came out okay, but when he was wheeled to recovery, he had massive bleeding, his heart rate and blood pressure dropped, and for almost one hour, on and off his heart stopped. Finally resusitated, they told us they needed to operate so they could suction the blood (at least 6 packs of blood and literally a dozen of people worked on him). They took him to the OR and did two incisions. He was in and out of consciousness for about 10 days and was on life support for about 7. Amazingly, he woke up, very confused and recovered. In mid-February, he went to a nursing home for rehab because he was in bed for so long, he couldn't really walk and do anything (feed himself, etc.). PT helped him w/walking and OT helped him w/his arms and hands. At the same time, he didn't have an appetite and was depressed. He wasn't happy w/the care there and made up stories as well (exaggerated the truth, I guess) He was there for a month when, yesterday, they called 911 because his heart rate dropped to the low 30's (his normally HR is about 50-60), and his nurse was worried. So the ambulance took him to the hospital. He's staying for the weekend and there's some talk about putting a pacemaker in him. UGH! So here we go again... do we put a pacemaker in a 90 year old man? He turns 90 tomorrow.
If he was strong enough and had an appetite, he's actually back to where he was in December before all of this happened. Any thoughts?
If he was strong enough and had an appetite, he's actually back to where he was in December before all of this happened. Any thoughts?
Gatormom
03-21-2004, 07:31 AM
. He wasn't happy w/the care there and made up stories as well (exaggerated the truth, I guess)
Me again, with the elderly Mom who had heart surgery 3 yrs ago - sorry to hear your Dad has had to go through so much. It is tough on the person and all those who love him! Comment on the above quote: after anesthesia a lot of older folks do have trouble getting their mental sharpness back, and might be confused in some ways for quite a while. In any institutional setting, such as rehab, hospital, or nursing home, they also seem to react to being in there with odd comments, misunderstanding of what we think is very ordinary (Mom couldn't understand why the clock hands went the "wrong" way!) and so forth - - I do believe it is just really hard to get their thinking straight after so much stress. We learned to find humor in it when we could, and thankfully her family memories are still there and she's sharp most of the time now. I would suggest that rather than pointing out exaggerations or what seems like lies, just "roll" with them if you can, and let your Dad tell you how it seems to him. Just having you listen probably helps him.
God bless you and hugs to your Dad, I hope he can feel better and find reasons to smile in the near future.
Me again, with the elderly Mom who had heart surgery 3 yrs ago - sorry to hear your Dad has had to go through so much. It is tough on the person and all those who love him! Comment on the above quote: after anesthesia a lot of older folks do have trouble getting their mental sharpness back, and might be confused in some ways for quite a while. In any institutional setting, such as rehab, hospital, or nursing home, they also seem to react to being in there with odd comments, misunderstanding of what we think is very ordinary (Mom couldn't understand why the clock hands went the "wrong" way!) and so forth - - I do believe it is just really hard to get their thinking straight after so much stress. We learned to find humor in it when we could, and thankfully her family memories are still there and she's sharp most of the time now. I would suggest that rather than pointing out exaggerations or what seems like lies, just "roll" with them if you can, and let your Dad tell you how it seems to him. Just having you listen probably helps him.
God bless you and hugs to your Dad, I hope he can feel better and find reasons to smile in the near future.
zip2play
03-21-2004, 11:23 AM
BoltsandNuts,
I'd go with the pacemaker; it's not serious surgery and rhythm control seems necessary.
It's a shame about that serious hemmorhage after your father's stenting. Methinks they will start rethinking that "push the Plavix" mentality. A serious bleed can be just as devastating as a serious clot. Oh well, it's expensive so it MUST be good.
My first clue of it's risks was the difficulty of stopping bleeding after they pulled the cattheter from my groin....I kept thinking "this CAN'T be right!"
I wonder if anyone is tabulating the frequency of these "oh-oh, another bleeder" incidents?
I'd go with the pacemaker; it's not serious surgery and rhythm control seems necessary.
It's a shame about that serious hemmorhage after your father's stenting. Methinks they will start rethinking that "push the Plavix" mentality. A serious bleed can be just as devastating as a serious clot. Oh well, it's expensive so it MUST be good.
My first clue of it's risks was the difficulty of stopping bleeding after they pulled the cattheter from my groin....I kept thinking "this CAN'T be right!"
I wonder if anyone is tabulating the frequency of these "oh-oh, another bleeder" incidents?
rcm11
06-25-2004, 12:30 AM
My mom is 91 and was a strong and fairly healthy lady until September of last year. Her back started hurting and she was taken to the hospital. Due to bad bones , a sliver had broken loose from her back bone and that was causeing the pain. However, because of a low heart rate at times the surgeon said he could not do the surgery unless she got a pace maker. Being of sound mind she first said no, then (she loved to fish) some nutty relative told her if she would have the surgery she could go fishing again even if she had to go in a wheelchair so she said yes. She had the surgery, She hasn't been able to get out of the bed since except by being picked up with a lift and put in a wheelchair, needless to say she never got to fish again. She has been bed ridden now for almost eleven months. She has a lot of pain and prays that God will take her.
90's is too old to try to prolong life. One may live to be 100 but that may be the worse thing that could happen if the quality of life is gone.
90's is too old to try to prolong life. One may live to be 100 but that may be the worse thing that could happen if the quality of life is gone.
NineLives
06-25-2004, 09:27 AM
Initially, he had said okay to bypass (I was worried that something bad would happen during the angiogram in which I had to make a decision, so we discussed this), but after a better discussion w/the attending physician, I found out that it would be a one-year recovery period... for a 90 year old, that one year could be crucial, so I had hoped he didn't choose that
I don't think a one-year recovery period is realistic! I was 41 when I had a single bypass and it was 18 months before I felt really good again. I had no other health problems and was a non-smoker.
I don't think a one-year recovery period is realistic! I was 41 when I had a single bypass and it was 18 months before I felt really good again. I had no other health problems and was a non-smoker.
SafetyJ2006
06-25-2004, 09:42 AM
I just read this very sad thread and what I have to say about this 90-year-old gentleman's physicians would probably be deleted by the moderator. This only serves to reinforce the indictment that some members of the medical community are in it only for the money and to hell with the Hippocratic Oath.
Nine Lives, thanks for reviving this old thread that I had never seen.
Jeff
:jester:
Nine Lives, thanks for reviving this old thread that I had never seen.
Jeff
:jester:
KShortie
06-27-2004, 01:06 PM
I agree with the other posters. I was only 46 at the time of my bypass and almost one year later I'm still recuperating. My cardiologist told me it will probably be another six months. 90 years old is much to big a risk for open heart surgery, heart/lung machine--much less the higher risk of postop infection, pnemonia, etc.
boltnut55
08-13-2004, 05:21 AM
I appreciate that some are still reading this thread and continue to comment... I hope it will help others. It's just good to hear the opinions when you have a problem and no information.
My last update was that he was in for a possible pacemaker. I questioned it for the usefulness part as well as the monetary part because he would have to pay out of pocket for all the doctors' bills (he is a veteran but wasn't taken to the VA hospital, which had no room anyway), and no one, including the doctors' offices could tell me how much he would have to pay (I was trying to figure out whether it'd be $1,000 or $50,000!), but the social worker made it sound like the doctor had already gotten my dad's permission and that I had no right to question it, especially on a monetary basis. The cardiologist later told me that he hadn't gotten permission. I presented the pros and cons to dad, and he opted for the pacemaker and did well in surgery.
He was taken to the nursing home for two more weeks of rehab, at which time he complained about everything again (refused to eat, told me stories about how poorly he was treated, etc.), and finally returned home to live w/a full time caregiver... this was April 9th.
In the past 4 1/2 months, he's been doing pretty well. His heart, cholesterol, and blood pressure, are better than before all of this happened. He is walking about the same as before the problems but possibly still a little weaker. He's eating well since the caregiver cooks well. He isn't really listening when we tell him foods that he should avoid (but really like), so we've decided to not withhold too much (he is 90 after all), but would point out the consequences when they occur, such as an episode of CHF after eating several meals of roast duck and other salty items that he insisted on.
A lot of the Monday morning quarterbacking thoughts come from whether something was a success or a failure. I think the decision to not have open heart surgery was right... even if it were "only" a one-year recovery time, it's too long for a 90 year old. Angioplasty was the right choice, but no one had control over the bleeding (although I still think they should have anticipated it - right after surgery was declared a success, he asked for a bedpan because of #2... I think he may have "pushed" and therefore something bled). The pacemaker was also the right choice... the "joke" is that he could potentially live forever!
My father is a very negative, grumpy, person. He's had a lot of bad things happened to him (he's very naive and was taken many times), and he carries all that baggage with him - he's always telling us about all those bad times, every time he's been cheated, everything my mom argued with him about. I keep hoping that God is giving him a few more years, so he will learn to be grateful for what he's had and to be happy... but it's so hard to change. <sigh>
My last update was that he was in for a possible pacemaker. I questioned it for the usefulness part as well as the monetary part because he would have to pay out of pocket for all the doctors' bills (he is a veteran but wasn't taken to the VA hospital, which had no room anyway), and no one, including the doctors' offices could tell me how much he would have to pay (I was trying to figure out whether it'd be $1,000 or $50,000!), but the social worker made it sound like the doctor had already gotten my dad's permission and that I had no right to question it, especially on a monetary basis. The cardiologist later told me that he hadn't gotten permission. I presented the pros and cons to dad, and he opted for the pacemaker and did well in surgery.
He was taken to the nursing home for two more weeks of rehab, at which time he complained about everything again (refused to eat, told me stories about how poorly he was treated, etc.), and finally returned home to live w/a full time caregiver... this was April 9th.
In the past 4 1/2 months, he's been doing pretty well. His heart, cholesterol, and blood pressure, are better than before all of this happened. He is walking about the same as before the problems but possibly still a little weaker. He's eating well since the caregiver cooks well. He isn't really listening when we tell him foods that he should avoid (but really like), so we've decided to not withhold too much (he is 90 after all), but would point out the consequences when they occur, such as an episode of CHF after eating several meals of roast duck and other salty items that he insisted on.
A lot of the Monday morning quarterbacking thoughts come from whether something was a success or a failure. I think the decision to not have open heart surgery was right... even if it were "only" a one-year recovery time, it's too long for a 90 year old. Angioplasty was the right choice, but no one had control over the bleeding (although I still think they should have anticipated it - right after surgery was declared a success, he asked for a bedpan because of #2... I think he may have "pushed" and therefore something bled). The pacemaker was also the right choice... the "joke" is that he could potentially live forever!
My father is a very negative, grumpy, person. He's had a lot of bad things happened to him (he's very naive and was taken many times), and he carries all that baggage with him - he's always telling us about all those bad times, every time he's been cheated, everything my mom argued with him about. I keep hoping that God is giving him a few more years, so he will learn to be grateful for what he's had and to be happy... but it's so hard to change. <sigh>
zip2play
08-13-2004, 09:02 AM
I'm glad to hear he's perking along and I hope he lives long enough to need the batteries on his pacemaker changed:D.
You two made all the right decisions.
You two made all the right decisions.