[msunderstoood]

Hi all,

I was just looking for some opinions from those that might have one or two on this matter... my mom is 74 y.o. she has emphysema, chf, htn, and 1.5 years ago her right carotid was 90% occluded. The MD put her on plavix and had set up an appointment with card's to have her artery cleaned out. At the time she was supposed to go in she ended up with pnemonia (on a vent) so she never went to the appointment so flash forward she has been sick this past june/july (on a vent, pnemonia, septic shock, mrsa, pseudomonas, etc...) so now she has settled down (healthwise) so I am looking for opinions on pushing her towards getting this done before it is too late. Does anyone have any opinions that might help or have had experience with this type of procedure should I push her really hard to have it done??? I can't see straight because it is my mother and the line between daughter and nurse is skewed so bad because of her last round of hospitalization that I could really use some honest opinions and guidance...thanks in advance

[Suesquatch]

What does her cardiologist say?

I would be hesitant to push someone so obviously weak and infection-prone to have such a major surgery.

You have to talk to her doc.

[msunderstoood]

She hasn't been back after the initial visit when the appointment was scheduled. The surgery would be a Carotid endarterectomy. I have not had any experience with this type of procedure especially in an aged population. I work with babies...

[Suesquatch]

My husband's mother had this done back in 1966 or 7. She died on the table.

You have to ask her doctor whether he thinks it wise for her to proceed. Seriously. She is clearly very debilitated with multiple comorbidities and only he knows her condition well enough to know whether she should have the surgery.

Push her to go see her regular doctor again and ask if you can accompany her to ask him questions.

[Dinith88]

Originally Posted by msunderstoood

She hasn't been back after the initial visit when the appointment was scheduled. The surgery would be a Carotid endarterectomy. I have not had any experience with this type of procedure especially in an aged population. I work with babies...

Like the previous poster said...it raises some alarms.

At first glance it seems your mom has fairly advanced lung disease (been on vent twice??) and/or chf/heart disease, etc...so it's a no-brainer that she'd be at a VERY high-risk for complications from the surgery.

The risks/benfits of treating medically -vs- surgical intervention is something her doctor needs to clarify with you in detail... everyone's different so a situation like this isn't (unfortunately) black and white.

Alternatively, you may want to ask her cardiologist about carotid stenting. It's fairly new, but it can be done in cath-lab without anesthesia/intubation. Some people arent candidates (for various reasons), but if her renal function is good, and the carotid isn't 'complicated', this may be a better option...as far as risks/complications. Ask him about it.

[Sweetooth EMT-P, RN]

MS the users of this sight are not suppose to give out medical advice as it is against TOS. I am sorry about your mom and I hope she begins feeling better soon. Your best bet would be to ask her doctor.

swtooth

[frances56]

Hi I'm sorry your mother is so sick. Surgery is dangerous for anyone but if your mother has been on a vent it sounds like she is a bad surgery candidate. Have you spoken to your mother about what she wants to do? If she didn't go back to the doctor sounds like maybe she doesnt want any further treatment. You need to support her in whatever decision she makes. Its hard to 'let go' but sometimes we havent any choice.

[msunderstoood]

Thank you for your replies. I want to assure you my question was more about pushing towards going to see a Dr. and understanding about being the nurse in the family and being able to separate yourself and just be a daughter. I am struggling with it. In my own job I find myself able to say "we are going too far", with my mom I just don't want to lose her. In the end I know if my mom wanted to get this done she would have been there already (a year ago). My mom isn't struggling with any decisions, just me. I have always gotten very good nursing advice from this site as far as "I have been in your shoes" and even with this post the advice that I know that what is best is to see her Dr. I already talked with my mom about just checking to see where things are right now with her artery a few days ago.

I remember being in the room with her while she was inpatient and on a vent and wanting so desperately to be the nurse and take care of her. We always think we know best I suppose. Yes, I am one of those nurses that insist that someone in the family is there (in the room or hovering in the waiting room) all the time. I lift the sheets I look at her skin, I listen to her breathing etc... I become one of those neurotic family members :-)

I just needed to say what I was feeling to people that would understand the struggle... and kick me in the behind.

[TachyBrady]

If I were you, I would ask your mother what her wishes are. I would accompany her to discuss options with her PCP (not the surgeon).

Before my Dad died almost 2 years ago, he endured multiple acute and chronic illnesses, hospitalizations, procedures, testing, etc. Finally, he said, "enough". My sister, wisely and bravely, suggested Hospice to him and he immediately agreed. He said he'd just had enough. A few days later, he died peacefully. I'm so glad we didn't push for OUR wants and needs and instead let him choose some peace for himself.

It is difficult but you need to consider:

* you mother's wishes
* her quality of life now
* discomfort of further testing and procedures
* possible outcomes, both positive and negative
* think of what you would want if it were you

Saying a prayer for you both...