[HSF] Just say no?

[Nasser F. Abou'Seada]

Very well said Dan

NFA

On Feb 13, 2008 11:15 AM, Dan Waters <DWATERS at mcclinic.com> wrote:

> I practice in an area of the country where there is a large population of
> healthy, elderly(>75) patients. In almost 20 years I have operated on a very
> large number of octagenarians, but only about a half-dozen nonagenarians.
> All but one of the 90 y/o's are still alive and that patient lived
> independently or in assisted-living(not a nursing home) for 11 years after
> surgery. I think it's safe to say we can get almost anybody, regardless of
> age, through the peri- operative phase. I have tried to reserve operation in
> this group for patients with a "quality" life-expectancy(independent or
> assisted-independent living, ability for self-care, etc.) of at least five
> years. Most of the 90+ y/o's  I have been asked to see would not meet this
> criterion. I am not sure why many of these patients come to catheterization
> in the first place, since, as we like to say, they don't appear to be
> candidates for a haircut, much less a major operation. I always perform the
> consultation, however, because many times our kindest act is to let the
> patient and family know that it's OK for them to decline surgery.  I am
> sometimes challenged by the cardiologists with the phrase, "Well, without
> surgery the mortality is 100%."  At 95 or 96,  what isn't?  Perhaps at some
> point 90 will be "the new 80" - I just don't think we're there yet.
>
> DJW
>
> >>> "Michael Firstenberg" <msfirst at gmail.com> 2/12/2008 9:04 pm >>>
>  92 year/old - previously functional, living and taking care of wife,
> driving......
>
> fell on ice, broke his hip
> had small MI (slight troponin leak)
> gets cath - severe multi-vessel CAD with left main and critical aortic
> stenosis (<0.8 cm2) - reported low gradient.
>
> ... he is in an ICU at an outside hospital requesting "surgical opinion"
>
>
> did I mention he is 92 with a broken hip?
>
> we have done a few of these, all or nothing....... but I cant see this
> poor
> guy ever walking, let alone leaving a nursing home.......
>
>
>
>
>
> -michael
> _______________________________________________
> 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
> -----------------------------------------
>