[HSF] Nonagenarians and Cardiac Surgery

Sat Nov 18 13:52:37 EST 2006

I would agree to Prasanna's argument, from a different conceptual framework.

In my culture (different faiths and different religions) people do believe
that the LENGTH of life is already predetermined -thought that might
conflict with some rhetorics - ..... in another word .... the time we as
humans are destined to materialize in this materialistic existence ...is
already pre-determined ..... meaning that life can't be prolonged .... can
not be shortened .... when the time comes ... it comes .... -I got that say
from an American Family, a doctor's family, I've been living with in
Cleveland- 

Still, surgical procedures -and medicine in general- is meant to be a REASON
to IMPROVE the QUALITY of life .... that we'd never know when it ends ....
hence we have to work on to improve ITS EXISTENCE .. till the unknown time
comes .. 

based on that ... my domain of thoughts would intersect with prasanna's and
others' ....in that:  surgical care should be offered to others -for
whatever reason of belief- to provide for good life, to improve quality of
life, to extend life ! ... yet the DETERMINANTS of the surgical decision
would count on many variables; age being one of them .... solely as a number
.... among other important variables ..... -as Hal described- 

we would arrive at the same destination at the end .... starting from a
different perspective .... 

NFA

> -----Original Message-----
> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
> bounces at lists.hsforum.com] On Behalf Of prasannasimha
> Sent: Saturday, November 18, 2006 12:46 PM
> To: OpenHeart-L at lists.hsforum.com
> Subject: Re: [HSF] Nonagenarians and Cardiac Surgery
> 
> I would put it in perspective -
> If the patient is active and desires surgery and seems an OK candidate -
> who are we to deny surgery just based on age if we can give a reasonable
> extension of life.
> If the patient is a frail old person who represents an inordinate risk
> and does not want it and is ready to make peace with his/ her maker then
> why should we operate. The decision should be based on the patients
> condition and desires and not our prejudices.
> The oldest patient I have operated was a 94 year old man who underwent
> non cardiac surgery by me. He had a diabetes  and hypertension and a
> host of other medical problems and no urologist was ready to operate on
> his prostate. He told me Doctor life is becoming miserable as I cannot
> get one nights rest. I operated on him in a private hospital and he
> lived for another 4 years and was thankful for it till he died. When his
> time was coming I told his Son's that I will not ventilate him etc etc
> and allowed him to die at home in peace. Was operating him wrong - in
> his view (which was good enough for me) No and he got to see his great
> great grandchild which was what his great desire. I do agree that
> cardiac surgery may be a different ball game but then who are we to deny
> surgery based on our own belief systems and prejudices ? No. You must
> realize I come from a community where old people do not want to have
> interventions done on them and if any one asks for surgery  - he has a
> compelling desire to do so and I will not deny that to him /her if that
> person is ready to accept the risks and consequences.
> remember the holy grail of medicine is meaningful prolongation of life.
> If prolongation of life is meaningful for someone at 90 years so be it.
> I would think that the reverse - doing a Norwood for a child with a
> chromosomal anomaly is somehow found acceptable by some whereas it may
> equally reprehensible. Are we to judge ?
> Prasanna
> 
> Salerno, Tomas wrote:
> > Sometimes it is important to pause and ask questions, such as operations
in 90>
> year-old patients...
> >
> > Tomas
> >
> > ________________________________
> >
> > From: openheart-l-bounces at lists.hsforum.com on behalf of Nasser F.
Abou'Seada
> > Sent: Sat 11/18/2006 12:20 AM
> > To: OpenHeart-L at lists.hsforum.com
> > Subject: RE: [HSF] Nonagenarians and Cardiac Surgery
> >
> >
> >
> >
> >> Age is a number to be considered, but I
> >>
> >>> feel obligated to evaluate the patient's cormorbidites, mental
> >>> acuity, mental outlook, etc, before categorically denying a patient
> >>> surgery just because they are in their 90's.<
> >>>
> >
> > Certainly Sounds Logic .... totally agree ........ though having no such
> > patient in such age group ...
> >
> > NFA
> >
> >> -----Original Message-----
> >> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
> >> bounces at lists.hsforum.com] On Behalf Of Edward Bender
> >> Sent: Friday, November 17, 2006 7:20 PM
> >> To: OpenHeart-L at lists.hsforum.com
> >> Subject: Re: [HSF] Nonagenarians and Cardiac Surgery
> >>
> >> I remember a 92 year old with disabling angina I did a CABG on a
> >> couple of years ago.  Discharged on post-op day 4, and then he went
> >> to Las Vegas to help set up an amusement park type train for a couple
> >> of the casinos.  There are 90 year olds and then there are 90 year
> >> olds.  Generalizations don't equate to universality.
> >>
> >> Ed Bender, MD
> >>
> >>
> >> On Nov 17, 2006, at 2:25 PM, hgrmd at aol.com wrote:
> >>
> >>
> >>> Tomas,
> >>>   I've done several patients in their 90's in my career.  Most of
> >>> them did reasonably and sometimes surprisingly well.  The key is
> >>> selection.  I generally won't operate on your average patient in
> >>> their 90's, but there are worthy exceptions.  Heck, I've turned
> >>> down some patients in their 30's or 40's because the cormorbidities
> >>> and the heart were so bad.  Age is a number to be considered, but I
> >>> feel obligated to evaluate the patient's cormorbidites, mental
> >>> acuity, mental outlook, etc, before categorically denying a patient
> >>> surgery just because they are in their 90's.  An example was the
> >>> sharp 93 yo grandmother of an internist who kept being admitted for
> >>> chest pain from severe 3vd.  I did her CABG, she did well, and was
> >>> living an active life at least 4 years later.  I'm sure plenty of
> >>> other members of HSF can relate similar experiences.
> >>> Hal
> >>>
> >>>
> >>> -----Original Message-----
> >>> From: TSalerno at med.miami.edu
> >>> To: OpenHeart-L at lists.hsforum.com
> >>> Sent: Fri, 17 Nov 2006 2:08 PM
> >>> Subject: RE: [HSF] Factor VII
> >>>
> >>>
> >>> Should a 90 year old be subjected to heart surgery? Anyone has seen
> >>> his/her grandmother at that age, and what she looks like?
> >>>
> >>> Tomas
> >>>
> >>> -----Original Message-----
> >>> From: openheart-l-bounces at lists.hsforum.com
> >>> [mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of Ben
> >>> Bidstrup
> >>> Sent: Friday, November 17, 2006 1:49 PM
> >>> To: OpenHeart-L at lists.hsforum.com
> >>> Subject: Re: [HSF] Factor VII
> >>>
> >>>
> >>>> Prasanna,
> >>>>   Basically, I wasn't thinking of the possible legal consequences
> >>>> when
> >>>>
> >>> I
> >>>
> >>>> used VII, because I knew the potential for such was nil.  No South
> >>>>
> >>> Florida
> >>>
> >>>> lawyer on contingency is going to take a case of a 90 yo cardiac
> >>>> surgical patient
> >>>> against a bare surgeon.  Now, if the patient had been in  her 50's
> >>>> with
> >>>>
> >>> a
> >>>
> >>>> difficult family, then I might have had other thoughts.
> >>>> Hal
> >>>> _______________________________________________
> >>>>
> >>> Hal,
> >>> I am sure very few of us in a situation like this think of anything
> >>> but the benefits for the patient. It is easy to be 'wise' after the
> >>> event and that is what we are able to do here.
> >>>
> >>> --
> >>> Ben Bidstrup FRACS FRCSEd FEBCTS
> >>> Consultant Cardiothoracic Surgeon
> >>> _______________________________________________
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