MGordon_MD
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Oct 23, 2007, 9:49 AM
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By Dr. Michael Gordon
The daughter who accompanied her Morris, her father said he just was not doing well. “He is almost immobilized. He can walk from the chair to the bed and to the bathroom, but hardly more than that.”
I had seen him some years before with a milder form of the same complaint and told him that there were things he might do short of surgery, but it might be necessary at some point in the future.
“I am too old for surgery” said Morris, who was at this time 80 years old. “My doctor told me it was too risky.”
This comment followed my suggestion that I refer him to a neurosurgeon, as his CT scan showed severe spinal stenosis which caused him great back and leg pain on walking and as noted by the daughter severely limited activities he previously enjoyed.
Morris’ daughter and son and his family physician convinced him to see me. He was feeling very depressed and they wondered if he might benefit from treatment for a mood disorder.
After the examination it was clear that he was not suffering from a primary depression suitable for emotional support and anti-depressant medications treatment. He was despondent because of his pain and loss of independent function. It had gradually progressed and initially responded to pain treatments, acupuncture and some chiropractic care.
He initially could manage but during the previous six months he became completely dependent on his children or a hired caregiver to get him out and about. At his best, he could no longer walk more than 25 feet without stopping for a few minutes because of pain, before being able to walk a short distance again.
He was miserable.
I reiterated my suggestion of a referral to a neurosurgeon. “I’m afraid of surgery” he lamented. “What if it doesn’t work?”
I explained that indeed it doesn’t always work and some people have bad outcomes, but I had a number of patients that did very well. I told him, getting a surgical opinion didn’t obligate him to surgery, but it will allow a better understanding of the risks and benefits of the operation.
The surgeon I referred to was very good with older people and explained things to them in a way that decreased their fear and anxiety and allowed them to consider their possibilities in a supportive and encouraging a way.
Morris then said to me as he agreed to go to the surgeon, “The way things are going right now, I don’t think I can go on – it is just too miserable”.
He returned to me after the surgical consultation – Morris had agreed and a date booked. He was quite animated when he spoke to me. “He thinks I have a pretty good chance of improvement and anything is better than what I have now – I decided to take my chances.”
I received the note some weeks later from the surgeon that the procedure had gone well. Morris was discharged home to an ambulatory rehabilitation program. I could hardly wait for the next visit – which occurred 2 months later.
I could hardly recognize Morris. He looked younger and I realized that his facial expression had changed – previously he had an almost perpetually pained look on his faced. I observed Morris round the corner of the clinic and he walked, unaided and briskly towards my office – it was a wonderful sight to behold.
During the visit he told me how the surgery went, some of the minor difficulties post-operatively, mainly related to his enlarged prostate – but that was dealt with and now the rehabilitation program it was going smoothly. He left, with a firm handshake and assured me that he would come again in six months to let me see his progress.
The important lesson that I learned from this patient is that we should not discount the possibilities of potentially beneficial surgery based on age criteria alone.
Current surgical and anesthetic techniques allow many older people to successfully complete challenging operations – joint reconstruction, bypass and other surgeries which can transform the quality of life from one of misery and dependency to one of comfort and personal fulfillment.
Explore, discuss and learn and then decide what feels good to you with your personality and your life goals. Get good advice, consider it and then decide whether or not to follow it. For some it is too much to consider whereas for others they are willing to take the chance for significant improvement, knowing full well that surgery doesn’t always succeed but when it does it can completely alter for the better, one’s life and function.
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Dr. Michael Gordon is Medical Program Director, Palliative Care Baycrest Geriatric Health Care System in Toronto, Canada and Professor of Medicine, at the University of Toronto. He is co-author with Bart Mindszenthy of Parenting Your Parents.
Parenting Your Parents is available in bookstores and online at: Indigo-Chapters, Amazon and Barnes & Noble. It is available in a US edition: Parenting Your Parents: Support Strategies for Meeting the Challenge of Aging in America.
For bulk orders email info@dundurn.com. Call: 416-214-5544 or Fax: 416-214-5556
(This post was edited by MGordon_MD on Oct 23, 2007, 10:43 AM)
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