(OT) Re: [HSF] Nonagenarians and Cardiac Surgery

Sun Nov 19 23:18:46 EST 2006

Now would not that be a wonderful principle to apply to med neg!

>I think that I have explained it in the previous post
>but, extension and prolongation of life are very  much within the 
>karmic thought.
>You were preordained to have the extension in life /or not 
>preordained based on your karma. The problem is that you cannot 
>fathom the nature of your karma till you walk the time line and it 
>is revealed to you so your interpretation is post hoc whereas the 
>karmic details were preordained based on your previous acts thoughts 
>and actions. Your thoughts , actions and deeds add to your Karmic 
>load and balance.
>When I talk to my patients while I explain the risks and benefits at 
>the end , I tell them the ultimate result will be based on God's 
>will and your Karma and they understand !! They agree or disagree 
>about surgery based on their interpretation of their Karma 
>(especially the elderly). Remember that Karma is not just fate. It 
>is a combination of fate, retribution to past deeds and misdeeds and 
>the preordained and the mess ups and good deeds that we have done in 
>this life and in the past. A little difficult to explain but I hope 
>you get it. The nearest that I can translate it into Urdu /Arabic is 
>Kismet though that is more fate than Karma.
>Prasanna
>
>Nasser F. Abou'Seada wrote:
>>then I suppose one must learn Hindu to save on thought, concept, logic,
>>philosophy and time ... would you elaborate then on how would you 
>>believe in the concept of
>>EXTENSION or PROLONGATION OF LIFE if you have "karma" ?
>>
>>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 8:40 PM
>>>To: OpenHeart-L at lists.hsforum.com
>>>Subject: Re: [HSF] Nonagenarians and Cardiac Surgery
>>>
>>>We have one word in Hindu philosophy for what Nasser said in many words
>>>"Karma"
>>>Prasanna
>>>
>>>Nasser F. Abou'Seada wrote:
>>>
>>>>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
>>>>>>>>_______________________________________________
>>>>>>>>OpenHeart-L mailing list
>>>>>>>>
>>>>>>>>Send postings to:
>>>>>>>>  OpenHeart-L at lists.hsforum.com
>>>>>>>>
>>>>>>>>To UNSUBSCRIBE, to CHANGE email address, or to view archives:
>>>>>>>>http://mmp.cjp.com/mailman/listinfo/openheart-l
>>>>>>>>
>>>>>>>>All messages transmitted by the OpenHeart-L are subject to the
>>>>>>>>policies
>>>>>>>>and
>>>>>>>>disclaimers posted at:
>>>>>>>>http://www.hsforum.com/listdisclaim
>>>>>>>>-----------------------------------------
>>>>>>>>_______________________________________________
>>>>>>>>OpenHeart-L mailing list
>>>>>>>>
>>>>>>>>Send postings to:
>>>>>>>>  OpenHeart-L at lists.hsforum.com
>>>>>>>>
>>>>>>>>To UNSUBSCRIBE, to CHANGE email address, or to view archives:
>>>>>>>>http://mmp.cjp.com/mailman/listinfo/openheart-l
>>>>>>>>
>>>>>>>>All messages transmitted by the OpenHeart-L are subject to the
>>>>>>>>policies and
>>>>>>>>disclaimers posted at:
>>>>>>>>http://www.hsforum.com/listdisclaim
>>>>>>>>-----------------------------------------
>>>>>>>>
>>>>>>>>
>>>>>>>>
>>>>>>>>
>>>____________________________________________________________________
>>>
>>>>>>>__
>>>>>>>
>>>>>>>
>>>>>>>
>>>>>>>>__
>>>>>>>>Check out the new AOL.  Most comprehensive set of free safety and
>>>>>>>>security tools, free access to millions of high-quality videos from
>>>>>>>>across the web, free AOL Mail and more.
>>>>>>>>_______________________________________________
>>>>>>>>OpenHeart-L mailing list
>>>>>>>>
>>>>>>>>Send postings to:
>>>>>>>>  OpenHeart-L at lists.hsforum.com
>>>>>>>>
>>>>>>>>To UNSUBSCRIBE, to CHANGE email address, or to view archives:
>>>>>>>>http://mmp.cjp.com/mailman/listinfo/openheart-l
>>>>>>>>
>>>>>>>>All messages transmitted by the OpenHeart-L are subject to the
>>>>>>>>policies and
>>>>>>>>disclaimers posted at:
>>>>>>>>http://www.hsforum.com/listdisclaim
>>>>>>>>-----------------------------------------
>>>>>>>>
>>>>>>>>
>>>>>>>>
>>>>>>>_______________________________________________
>>>>>>>OpenHeart-L mailing list
>>>>>>>
>>>>>>>Send postings to:
>>>>>>>  OpenHeart-L at lists.hsforum.com
>>>>>>>
>>>>>>>To UNSUBSCRIBE, to CHANGE email address, or to view archives:
>>>>>>>http://mmp.cjp.com/mailman/listinfo/openheart-l
>>>>>>>
>>>>>>>All messages transmitted by the OpenHeart-L are subject to the
>>>>>>>
>>policies
>>
>>>>>>>
>>>>>>and
>>>>>>
>>>>>>
>>>>>>
>>>>>>>disclaimers posted at:
>>>>>>>http://www.hsforum.com/listdisclaim
>>>>>>>-----------------------------------------
>>>>>>>
>>>>>>>
>>>>>>>
>>>>>>_______________________________________________
>>>>>>OpenHeart-L mailing list
>>>>>>
>>>>>>Send postings to:
>>>>>>  OpenHeart-L at lists.hsforum.com
>>>>>>
>>>>>>To UNSUBSCRIBE, to CHANGE email address, or to view archives:
>>>>>>http://mmp.cjp.com/mailman/listinfo/openheart-l
>>>>>>
>>>>>>All messages transmitted by the OpenHeart-L are subject to the
>>>>>>
>>policies
>>
>>>>and
>>>>
>>>>
>>>>>>disclaimers posted at:
>>>>>>http://www.hsforum.com/listdisclaim
>>>>>>-----------------------------------------
>>>>>>
>>>>>>
>>>>>>_______________________________________________
>>>>>>OpenHeart-L mailing list
>>>>>>
>>>>>>Send postings to:
>>>>>>  OpenHeart-L at lists.hsforum.com
>>>>>>
>>>>>>To UNSUBSCRIBE, to CHANGE email address, or to view archives:
>>>>>>http://mmp.cjp.com/mailman/listinfo/openheart-l
>>>>>>
>>>>>>All messages transmitted by the OpenHeart-L are subject to the
>>>>>>
>>policies
>>
>>>>and
>>>>
>>>>
>>>>>>disclaimers posted at:
>>>>>>http://www.hsforum.com/listdisclaim
>>>>>>-----------------------------------------
>>>>>>
>>>>>>
>>>>>>
>>>>>>
>>>>>_______________________________________________
>>>>>OpenHeart-L mailing list
>>>>>
>>>>>Send postings to:
>>>>>  OpenHeart-L at lists.hsforum.com
>>>>>
>>>>>To UNSUBSCRIBE, to CHANGE email address, or to view archives:
>>>>>http://mmp.cjp.com/mailman/listinfo/openheart-l
>>>>>
>>>>>All messages transmitted by the OpenHeart-L are subject to the policies
>>>>>
>>>>>
>>>>and
>>>>
>>>>
>>>>>disclaimers posted at:
>>>>>http://www.hsforum.com/listdisclaim
>>>>>-----------------------------------------
>>>>>
>>>>>
>>>>_______________________________________________
>>>>OpenHeart-L mailing list
>>>>
>>>>Send postings to:
>>>>  OpenHeart-L at lists.hsforum.com
>>>>
>>>>To UNSUBSCRIBE, to CHANGE email address, or to view archives:
>>>>http://mmp.cjp.com/mailman/listinfo/openheart-l
>>>>
>>>>All messages transmitted by the OpenHeart-L are subject to the policies
>>>>
>>and
>>
>>>>disclaimers posted at:
>>>>http://www.hsforum.com/listdisclaim
>>>>-----------------------------------------
>>>>
>>>>
>>>>
>>>_______________________________________________
>>>OpenHeart-L mailing list
>>>
>>>Send postings to:
>>>  OpenHeart-L at lists.hsforum.com
>>>
>>>To UNSUBSCRIBE, to CHANGE email address, or to view archives:
>>>http://mmp.cjp.com/mailman/listinfo/openheart-l
>>>
>>>All messages transmitted by the OpenHeart-L are subject to the policies
>>>
>>and
>>
>>>disclaimers posted at:
>>>http://www.hsforum.com/listdisclaim
>>>-----------------------------------------
>>>
>>
>>_______________________________________________
>>OpenHeart-L mailing list
>>
>>Send postings to:
>>  OpenHeart-L at lists.hsforum.com
>>
>>To UNSUBSCRIBE, to CHANGE email address, or to view archives:
>>http://mmp.cjp.com/mailman/listinfo/openheart-l
>>
>>All messages transmitted by the OpenHeart-L are subject to the 
>>policies and disclaimers posted at:
>>http://www.hsforum.com/listdisclaim
>>-----------------------------------------
>>
>>
>_______________________________________________
>OpenHeart-L mailing list
>
>Send postings to:
>OpenHeart-L at lists.hsforum.com
>
>To UNSUBSCRIBE, to CHANGE email address, or to view archives:
>http://mmp.cjp.com/mailman/listinfo/openheart-l
>
>All messages transmitted by the OpenHeart-L are subject to the 
>policies and disclaimers posted at:
>http://www.hsforum.com/listdisclaim
>-----------------------------------------

-- 
Ben Bidstrup FRACS FRCSEd FEBCTS
Consultant Cardiothoracic Surgeon