89 Y O Women with Congestive Heart Failure

[BUGGS2844]

Hello,

My 89 Y O Mom is having a hip replacement in two weeks. She has an enlarged heart and is showing slight signs of Congestive Heart Failure.  She has had many (10 or so+) TIA's in the past.  Does this surgery pose a huge threat to her life and why.

Thanks for your input/honesty.  I need it!

Betsy

[Yvette BG]

Wow! Surgery to build a dialysis fistula under "twilight." Who knew? (Actually, I'm learning that a lot of surgeries can be done under "twilight" vs. general sedation, which is great because it is less risky.)

BUGGS2844--When my Dad (age 81 at the time) had prostate surgery, his heart situation wasn't the best, but after weeks of monkeying around with urinary catheters in and out and ER visits for serious bladder distention (long story) as well as postponing surgery to work up the heart arrhythmia that showed up on the pre-op EKG, the urologist finally agreed to do the prostate surgery. Anyway---We made sure the surgery could be done at the main hospital where his cardiologist worked at, and then asked the urologist if he would talk with the cardiologist again and let him know surgery was proceeding so he could be kind of "on call" in case a cardiac emergency came up. The cardiologist checked my Dad the day of the surgery and also talked with the anaesthesiologist (I know that's spelled wrong) ahead of time about his cardiac issues. This helped make us feel better. Maybe you could arrange something like that for your Mom. They might not be willing to do it--but it doesn't hurt to ask. Please let us know how things go for your Mom.  

[gmachris518]

As horrific as it sounds, they can perform surgery on someone with CHF by not putting them completely out for the surgery.

I have CHF and kidney failure.  A little over 4 weeks ago I underwent surgery to build a dialysis fistula(vein grafted to an artery).  They put me into a "twilight" state, but told me that if they shook me, I would wake up and be able to talk to them.  It sounds awful, and scarey, but the truth is, I didn't feel a thing, nor do I remember being cut, so it's not as bad as it sounds. Of course, fistula surgery and hip surgery are miles apart as far as severity, but the actual surgery shouldn't be the problem.  I would worry more about after she wakes up.  From personal experience, I know the older a person gets, the harder it is for them to bounce back, and at 89....I should be so lucky as to live that long.  Way to go, Mom!!!

I do know that breaking a hip can be deadly, but I think Yvette is right.  The main problem would be her lungs filling up with fluid, espcially with CHF, so keeping her upright as much as possible, and ambulatory are very important.

My next question is, who would do the surgery?  At 89 years old, I think finding a surgeon would be a problem.  Does she has regular health insurance, or Medicare?  It shouldn't matter, but Medicare doesn't pay very well, and most doctors will ONLY do the bare neccessities for a patient, which is a whole new can of worms that REALLY sets me off when I get started ranting about it, so I'll just let it go, except to say Seniors get shafted when they reach a certain age, and I think it's terrible.  

There is a formula for figuring out if a person is "worth" paying for big medical proceedures.  It has to do with age, and how many more years of "worthwhile" life a patient would have, versus the cost of the surgery.

Here's an example:

I need a kidney tranplant, and I'm 56 years old.  My husband who is 61 years of age has offered one of his kidneys.  However, since he is over 60,  they don't want to use him as a donor.  I couldn't believe that his age would be a factor, but it is.  Doesn't matter anyway, because my EF is 15% and I won't qualify for the surgery anyway, because I need a heart also, and the "cost" outweighs the benefit.  Yes, there's the formula rearing it's UGLY head.

Anyway, I hope all the best for your Mom, and I'm impressed that she is still up and moving at 89.

[BUGGS2844]

Thanks for your comments.  My Mom can't walk much because of the hip pain and also because her leg doesn't move well.  Sometimes she has to ask people to lift it for her.  I guess my biggest worry is that her internist has been telling her for 5 years that she cannot have the surgery because the risk is too high.  She has made her decision (with the docs being very frank with her) that she can no longer live with the pain and it's a risk either way.  She'll either fall and have to have surgery or she can elect to have the surgery before she falls and try to improve her quality of life, whatever extent that might be.    

Thanks for your support.  I'm just scared.  

[Yvette BG]

Hi--Well, if a person has cardiovascular disease, they do have a higher risk of surgical complications or death than someone who doesn't have heart disease. I'm not a doctor and I don't know the statistics.

I can imagine you're worried. If they can do whatever they can to get her heart failure under the best control as possible before the surgery, that would be a good thing. Also, an I correct in assuming her ability to walk around is somewhat limited right now due to pain? If yes, then whatever you or maybe a physical therapist can do to help strengthen your Mom up and keep her moving as much as safely possible before the surgery would be advisable as well. Same thing goes for after the surgery, because if a person is relatively immobile, they are at higher risk of developing pneumonia and with CHF, that could be a bad (potentially deadly) combo.  

Has she been eating OK lately? That's another important preventative-type thing you can possibly help with. Like if she's been anemic in the past and hasn't been tested lately, ask the doctor to test her and try to get that under control now as well.

Good luck!