Mom (89) was admitted to the hospital after a heart attack this eve. Wondering if we should put her through a cardiac catheterization?
Mom has Alzheimer's, is happy and in pretty good physical shape. She is in the advanced stage, cannot be alone, needs full time care... just wondering if we should put her through a cardiac cath?
You didn't say if your mom has an Advanced Medical Directive. I think that makes it easier. When I started doing research on end of life issues, I explored the issues surrounding doing tests, procedures, surgeries and treatments for patients who are terminally ill. And since dementia is a terminal illness, I read the material and recommendations by professional organizations, like the American Cancer Society, with that in mind.
With my LO, we have Palliative Care (Comfort Care) and screenings and tests that are not directly related to her comfort are not performed. I might would ask the doctor how comfortable mother would be without this cardiac procedure. Is there anything less invasive?
And the advice above about DETAILS of the procedure and the aftercare are spot on. For some reason, many doctors just don't GET what it's like to manage a person with dementia for long periods of time. They don't understand that you can't just tell a person with dementia to not touch their eye or to lay still. They either cannot process it or they forget in 5 seconds. Aftercare with a dementia patient can be a very huge deal. IMO, it's sometimes not feasible to go that route.
PLUS, the patient can't understand why they are there, where they are, why they are being poked, and put in strange rooms. It's just frightening to them.....and for what? So they can live with no idea who they are for more years? Or what if there are complications and they get worse off and are bed bound after that or pick up an infection that causes pain and suffering? I would weigh the risk vs. the benefit. It's a personal decision. I am so glad that my LO made her wishes known long before she got dementia and I have done the same.
There are folks in the cardiac care community which advise against caths after heart attacks in favor of a plant based diet to reverse disease. That method takes months and those patients are willing to take that risk and decline the heart catheterization.
Also, if you decide that it’s ok for her to have the cath, ask her cardiologist what will happen if they find blockages in her coronary arteries. Often the cardiologist, if they decide they can, will stent (open the vessel up via balloon) the blocked blood vessel during the cath as they are right there already - at the coronary arteries- and if a stent is necessary they may do it.
Thus, think about the results as discussed above, and that you will have to decide to allow them to treat the condition or not.
The catheterization procedure can also diagnose blockages that can only be fixed by cardiac bypass surgery. Often if these are found they will complete the test and make arrangements for the bypass surgery in a day or two. Or...the test can determine if the person can’t wait for a day or two and make arrangements for the bypass surgery as soon as possible.
Tough decision for you and your family. Not knowing her past medical history we here can’t determine what the best treatment would be for her.
Good luck with whatever you decide and keep us posted.
Patti; My heart goes out to you! As everyone above says, ask more questions about why they want to do the catheritization. Make sure that the interventional cardiologist knows that mom has advanced dementia.
One of the things you need to know about cardiac catheritization (my husband had one done before open heart surgery several years ago, so things may have changed) is that the patient MUST NOT raise their head after the procedure for several hours. My curious as a cat husband, with no dementia, forgot this instruction and so of course picked his head up afterwards to look around. this can apparently lead to an embolism (an air bubble traveling through the blood system, which can kill you (!)).
The after treatment of catheritization was that he had to lie absolutely flat for, I think, 6 hours. He still says it was by far the worst part of the surgery.
Get the cardiologist to tell you EXACTLY what the procedure involves, and think about if your mom can tolerate it.
Several years ago, we agreed to a pacemaker for my mom with not so advanced dementia. They told us that they would place a temporary one and hold her overnight in ICU. What they didn't tell us is that they would restrain her and forget to give her her regularly scheduled anti anxiety meds overnight.
I would think that if you are going to put mom through this procedure, someone, family member or hired caregiver that she is familiar with, needs to attend her 24/7.
Is the cath being suggested as a diagnostic procedure -- a test only? If so, what would you do with the results? Would she then have additional treatments? Don't do the tests if you wouldn't do the treatments.
Is the procedure also going to provide some treatment? For example, is a valve replacement being suggested?
Be sure you understand exactly what the cath is for, whether additional procedures might follow, and how having this done will improve your mother's quality of life. Keep in mind what your mother attitude toward these things was when she was well. Does she have a health care directive that can help guide you in the decision?
Personally if were 89 with advanced dementia, I would not want a cardiac cath. I hope I can update my health care directive to make that clear. But that is only my decision for myself. I can imagine how agonizing this decision must be for you. Do your best, with love. There are no wrong answers here.
It sounds as if the question you want to ask your mother's attending physician is: "what happens if we don't do this procedure?" There may be acceptable alternative treatment options, but you need to be guided by people with clinical expertise.
Just by the way. Alzheimers Disease is not in itself a valid reason to deny patients life-saving treatment if the treatment's benefits far outweigh its risks. But if the treatment is painful or frightening and its results are uncertain, that is a valid reason. Keep asking questions until you are confident that you can make the best decision for her.
It's very tough, I'm sorry your family is having to deal with this.
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With my LO, we have Palliative Care (Comfort Care) and screenings and tests that are not directly related to her comfort are not performed. I might would ask the doctor how comfortable mother would be without this cardiac procedure. Is there anything less invasive?
And the advice above about DETAILS of the procedure and the aftercare are spot on. For some reason, many doctors just don't GET what it's like to manage a person with dementia for long periods of time. They don't understand that you can't just tell a person with dementia to not touch their eye or to lay still. They either cannot process it or they forget in 5 seconds. Aftercare with a dementia patient can be a very huge deal. IMO, it's sometimes not feasible to go that route.
PLUS, the patient can't understand why they are there, where they are, why they are being poked, and put in strange rooms. It's just frightening to them.....and for what? So they can live with no idea who they are for more years? Or what if there are complications and they get worse off and are bed bound after that or pick up an infection that causes pain and suffering? I would weigh the risk vs. the benefit. It's a personal decision. I am so glad that my LO made her wishes known long before she got dementia and I have done the same.
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Thus, think about the results as discussed above, and that you will have to decide to allow them to treat the condition or not.
The catheterization procedure can also diagnose blockages that can only be fixed by cardiac bypass surgery. Often if these are found they will complete the test and make arrangements for the bypass surgery in a day or two. Or...the test can determine if the person can’t wait for a day or two and make arrangements for the bypass surgery as soon as possible.
Tough decision for you and your family. Not knowing her past medical history we here can’t determine what the best treatment would be for her.
Good luck with whatever you decide and keep us posted.
One of the things you need to know about cardiac catheritization (my husband had one done before open heart surgery several years ago, so things may have changed) is that the patient MUST NOT raise their head after the procedure for several hours. My curious as a cat husband, with no dementia, forgot this instruction and so of course picked his head up afterwards to look around. this can apparently lead to an embolism (an air bubble traveling through the blood system, which can kill you (!)).
The after treatment of catheritization was that he had to lie absolutely flat for, I think, 6 hours. He still says it was by far the worst part of the surgery.
Get the cardiologist to tell you EXACTLY what the procedure involves, and think about if your mom can tolerate it.
Several years ago, we agreed to a pacemaker for my mom with not so advanced dementia. They told us that they would place a temporary one and hold her overnight in ICU. What they didn't tell us is that they would restrain her and forget to give her her regularly scheduled anti anxiety meds overnight.
I would think that if you are going to put mom through this procedure, someone, family member or hired caregiver that she is familiar with, needs to attend her 24/7.
Is the procedure also going to provide some treatment? For example, is a valve replacement being suggested?
Be sure you understand exactly what the cath is for, whether additional procedures might follow, and how having this done will improve your mother's quality of life. Keep in mind what your mother attitude toward these things was when she was well. Does she have a health care directive that can help guide you in the decision?
Personally if were 89 with advanced dementia, I would not want a cardiac cath. I hope I can update my health care directive to make that clear. But that is only my decision for myself. I can imagine how agonizing this decision must be for you. Do your best, with love. There are no wrong answers here.
Just by the way. Alzheimers Disease is not in itself a valid reason to deny patients life-saving treatment if the treatment's benefits far outweigh its risks. But if the treatment is painful or frightening and its results are uncertain, that is a valid reason. Keep asking questions until you are confident that you can make the best decision for her.
It's very tough, I'm sorry your family is having to deal with this.