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Heart murmurs are seldom lethal. What suggestions have been made that your wife should have heart surgery, and by whom? I know of few physicians who would be willing to do heart surgery on a demented elder. The anesthesia requirements alone for such a surgery could be seriously injurious, much more so than a heart murmur. In the event that a doctor is suggesting heart surgery for an elder family member of mine, the answer would be "no" in my case. I also would decline ANY tests that are even minimally invasive, while others, such as echocardiograms I would allow for the information they can provide. If you are POA for your wife you would be responsible for making decisions in the best interest of your wife, to the best of your ability. As a cardiac RN my entire career I would agree with your decision to decline such surgery. Were I told then that death would be imminent without surgery I would request hospice assessment. I wish you good luck. Please be certain that the hospital Social Worker and Ethics Committee assist you if your wife is hospitalized.
I believe when someone has dementia, care of their physical body should focus on comfort and not longevity. My father had CHF and a salt-restricted diet so I made a lot of soups and the soft food he required. I had a major dispute with one brother who wanted to give Dad anything he wanted, no matter how salty it was. I didn't have any problems with my Dad having anything to eat he wanted, so long as it didn't make his CFH any worse. Water retention can make someone very uncomfortable and can actually cause the skin to split and make very painful wounds. Dad loved Chex mix, but I insisted he only ate my homemade mix where I could control the amount of salt.
I suggest you ask her doctor what he/she wants to learn from the tests and what the treatment options will be depending on the test results. I did not authorize tests where the treatment wouldn't change or where I would not support the treatment in any case. If she has a heart murmur that causes her discomfort when her heart has "spells" or makes her more likely to have a stroke, I would have a pacemaker installed for her daily comfort.
I was very worried about how my dad with vascular dementia would do when he needed a hip replacement at age 82; I was afraid he wouldn't do well with the rehab, forget to use a walker, not cooperate with therapists, etc. But he was in pain and likely to suffer a broken hip and fall at some future time if he didn't have the replacement, so I reluctantly supported the decision to have the surgery. He did wonderfully and rehabbed completely.
I found the questions of medical treatment to be one of the hardest parts of caring for someone with dementia. My process was to ask myself what mom or dad would have chosen when they didn't have dementia, what declining treatment would mean to their daily life in terms of discomfort or anxiety, then what they could cope with considering they did have dementia. Although I was the POA or guardian, I found talking things over with my brother and co-POA was extremely helpful, not only to make the decisions but to live with a sense that I had made the "right" decision. I encourage you to find someone, whether a relative or friend, to discuss your decisions with and gain the support you will need.
God bless you and guide you on your journey in caring for your wife.
The advice here on the forum is sound. A good place to start is to discuss this decision with her primary healthcare provider--perhaps get a living will/advanced directives into her charting paperwork. If she isn't symptomatic then it sounds like you would want conservative care--make this clear to the providers. It might be helpful for the provider to give you a consult to a palliative care team. In palliative care the person is still treated, but the treatment goals are to maintain a level of comfort, rather than a cure.
My husband also has CHF, chronic A-Fib, Pulmomary Hypertension and high blood pressure. After a fall and 2 surgeries for subdural hematoma in four days, he was taken off his blood thinners. He was recommended for the Watchman procedure, but 2 days before the procedure, he made me call our PCP. After the discussion, they (hubby and PCP) decided not to go ahead with it. As our PCP told me later, why put him thru the risk at 80 with dementia along with the other medical issues.
I've always had a heart murmur which became noticeably worse during chemo. I had a complete cardio workup prior to chemo, so they just monitored me.
As I was only 63 when I got cancer, they weighed that into treatment. Post chemo, I still have the murmur, it's slightly more noticeable, I guess, but we haven't had any talks about 'doing' anything about it.
Everyone is different. If any procedures make her uncomfortable--ask how important they actually are. Most heart procedures don't hurt, they are just time consuming and annoying.
It really depends on whether the murmur is indicative of circulatory problems. She could have an echocardiogram which is essentially an ultrasound of the heart and how the muscles interact and can let the doctor know how well her heart is functioning. If her heart is functioning well, then she needs no other treatment. If the heart valve is not functioning well, then you need to decide with the doctor if it is worth replacing her valve surgically. If she gets a donated valve, she will need to be on anti-rejection medication for the rest of her life. If she gets a mechanical valve, she will need to be on blood thinners the rest of her life. Both have risks and benefits. If your wife has advanced dementia, I would recommend not getting a valve replacement and just treat her with medications - but get the echocardiogram.
With her Alzheimer's you are very right to limit any activities, tests, etc that would be upsetting to her. Once when I was facing a medical procedure that was only for information, not curative, I was asked what I was going to do with the information. Basically if I was unlikely to act on the information did I really need too put myself through the trauma of the tests. I think that is a question you'll need to keep asking yourself as you guide your wife's medical journey. If I don't intend to get the surgery why should I get the test.
I don't know her stage of Alzheimer's so don't know how much she can participate in the decision process but, personally, I'd always err on the side of too little intervention rather than too much.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
In the event that a doctor is suggesting heart surgery for an elder family member of mine, the answer would be "no" in my case. I also would decline ANY tests that are even minimally invasive, while others, such as echocardiograms I would allow for the information they can provide.
If you are POA for your wife you would be responsible for making decisions in the best interest of your wife, to the best of your ability. As a cardiac RN my entire career I would agree with your decision to decline such surgery. Were I told then that death would be imminent without surgery I would request hospice assessment.
I wish you good luck. Please be certain that the hospital Social Worker and Ethics Committee assist you if your wife is hospitalized.
I suggest you ask her doctor what he/she wants to learn from the tests and what the treatment options will be depending on the test results. I did not authorize tests where the treatment wouldn't change or where I would not support the treatment in any case. If she has a heart murmur that causes her discomfort when her heart has "spells" or makes her more likely to have a stroke, I would have a pacemaker installed for her daily comfort.
I was very worried about how my dad with vascular dementia would do when he needed a hip replacement at age 82; I was afraid he wouldn't do well with the rehab, forget to use a walker, not cooperate with therapists, etc. But he was in pain and likely to suffer a broken hip and fall at some future time if he didn't have the replacement, so I reluctantly supported the decision to have the surgery. He did wonderfully and rehabbed completely.
I found the questions of medical treatment to be one of the hardest parts of caring for someone with dementia. My process was to ask myself what mom or dad would have chosen when they didn't have dementia, what declining treatment would mean to their daily life in terms of discomfort or anxiety, then what they could cope with considering they did have dementia. Although I was the POA or guardian, I found talking things over with my brother and co-POA was extremely helpful, not only to make the decisions but to live with a sense that I had made the "right" decision. I encourage you to find someone, whether a relative or friend, to discuss your decisions with and gain the support you will need.
God bless you and guide you on your journey in caring for your wife.
When my mom developed dementia, my brothers and I cut WAY down on interventions and tests. They just made mom anxious.
I will say that when her heart started beating very slowly and she was hospitalized, she herself consented to the implantation of a pacemaker.
As I was only 63 when I got cancer, they weighed that into treatment. Post chemo, I still have the murmur, it's slightly more noticeable, I guess, but we haven't had any talks about 'doing' anything about it.
Everyone is different. If any procedures make her uncomfortable--ask how important they actually are. Most heart procedures don't hurt, they are just time consuming and annoying.
I don't know her stage of Alzheimer's so don't know how much she can participate in the decision process but, personally, I'd always err on the side of too little intervention rather than too much.