Bladder “tack” surgery in 81 yr. old with COPD, anxiety?

duplicate!

Molly, I haven't read to the end yet. Just HUGE ((((hugs))))). Will get back to you, as will everyone.

Love you!!!!

First—I don’t think your post is gross :)
unfortunately for us women, especially those of us who have had children, our bladders and uterus tend to....”fall down” in our later years. If you are concerned about the risks of having surgery with her COPD.... Her lung doctor is a good person to discuss the risk of surgery with. I can tell you that my mom has had COPD for years and has been on oxygen for years and she was able to be put under for a lung biopsy 2-3 years ago. It went fine, no complications. If her lung doctor is the one who prescribes her anxiety meds, I would definitely ask about getting the dosage increased before the surgery. For anything having to do with her breathing, my mom always goes to her lung doctor not her PCP but your MIL may prefer her PCP so that’s something to consider.

If she chooses not to have the surgery then rest assured, nursing home staff are trained to deal with prolapsed bladders. If someone has to help her manually....express her bladder (I am sorry if that is offensive, I couldn’t think of another way to say it) then the CNAs or even a nurse will help with that. My cousins old girlfriend was a CNA and she had a patient that was paralyzed from the neck down and she had to manually give her a bowel movement.

General anesthesia is often hard on any elder and a real danger, but one with COPD is at GREAT RISK. I am very surprised that they are recommending this surgery and cannot help but believe that if they are they see no alternative. That said she has been living with this for a long time. You should discuss all of this very thoroughly and very CAREFULLY with pulmonary specialist, anesthesiologist and the surgeon before moving forward because as a nurse I will tell you right now that this is terrifying to me. Do you know how long it has been this bad? Is she able to tell you? And no, nothing gross about our poor bodies. They do the best they can for us, until they cannot any more.
Side note: Queen Victoria, due to all the children she had, had quite the terrible prolapse all her latter years. Found on exam after her death, and apparently had been known to her doctors.

Molly, please see my note to you in replies below. I am truly very very concerned about her going forward without someone having POA for health care, complete discussion with surgeon. To my mind, the surgeon not insisting she get a workup from her Pulmonary specialist before this is done is already a massive red flag on this. Please be certain everything is done before, because at BEST this is very risky to her mental health. I am not so concerned with death as I am with life changed. There is no reason now to be rushed into anything; this has been going on some time now. Are we certain this is a collapse of the bladder and not of the uterus, or is it both. You must have a complete discussion with MD as POA and be her advocate here. See not note below.

I would question what post op looks like. Does she need to modify activity for an extended period of time, will she?

My dad has been put under several times since he was diagnosed with dementia and it hasn't phased him. It is not a given that there will be an adverse effect to anesthesia. If her pulmonologist says she is safe, I would do it. That has to be terribly uncomfortable and I think it is probably an infection risk. There is a reason we were created with things inside our bodies and not on the outside.

I would do it before she gets worse.

Great big hugs to that stoic woman. She is tougher than she knows.

A Pessary might be another solution. Poise makes a bladder support you insert daily like a tampon.

My Mom also has COPD and has been on oxygen for 10 years. She had a craniotomy 7 years ago and came through that just fine. She also had a suprapubic catheter (under anesthesia) put in 2 years ago and came through that fine as well.

I would think leaving things as is could cause bigger issues down the road. I think it would increase her risk for infections and that could also put her in the hospital. She may be able to manage it herself now, but what about later?

Bottom line is, what does MIL want to do? Her wishes should be respected.

While I absolutely understand and agree with everyone’s concern about putting someone with COPD under antastiesia there can be a wide variety of needs or degree of issue in patients diagnosed with COPD I have found. My exposure to COPD patients as an EMT had been much like most here it seems until I noticed my mother had this diagnosis as well. Her breathing can get labored at times when she is in heart failure or she is retaining fluid in her plural space or elsewhere but she has never needed oxygen as a result (other than in the hospital) and it has never been an issue with the several procedures she has needed over the years where she is put under. It may very well be that this posters (OP) MIL has a similar level, if you will, of COPD. She doesn’t need oxegyn according to what I have read and her anxiety is the main threat to her breathing, most people with major anxiety issues know the feeling of not being able to breathe properly/air hunger, it can often become a vicious cycle when anxiety hits.

If MIL’s pulmonologist, OB and PC are recommending this surgery there is probably a significant benefit and the timing as OP says is likely never going to be better. It’s her anxiety that does and will pose the most significant threat, aside from the normal risk of any surgery and I think addressing this clearly and proactively both for possible surgery and to minimize COPD symptoms/issues on going. The decision to do this surgery or not should absolutely include knowing the risks as well as the benefits and weighing them out but sure seems to me there is a huge benefit now and in the future of not having to “express” one’s bladder whether it be self assisted or caretaker assisted. I’m with you Mollymouse, ewwww!

I whole heartedly agree with the urging to get her legal stuff (POA, DPOA, Advanced Directives) in order though now whether she has sugary or not. I’m going to guess your husbands reluctance is at least partly mixed up in what happened to his father, I too would be terrified of the responsibility of making medical decisions after an experience like that as well as bringing anything up with Mom that might bring it all back. But as you obviously know MM not getting these legal documents in order could prove much more harmful, worse for everyone down the line. As unenviable as it is it sounds to me that you are in the position of needing to take charge (gently but firmly) and make these things happen. Since you say your MIL is likely to go along with it easily and the three of you have a great relationship hopefully she wont shy away from sharing medical info through doctors and having a DIL to ease the embarrassment of some of these issues (it can be harder To discUss with a son and harder for him to hear details) and maybe opening that avenue will encourage her to get more comfortable being open about things going on, new and old. Maybe you just need to get the forms in order and ready and then schedule a time for them to be signed, no should we do this just use the assumption close “I have one for (husband) and if you both decide having me as aback up is a good idea we can do that but I am also fine with simply listing me on HIPPA forms or giving me MPOA only so I am not constrained when it comes to helping with medical stuff.” Then once that is done if there isn’t a will or set good set up for the future over all you can suggest having an attorney go over it all and change things if a new set up makes more sense. Ease both of them into it but make it happen.

Good luck, MIL and your husband are so very lucky to have you in their corner but I know it isn’t easy.

You have to talk with the doctors to see if she can really handle this surgery.  If she can, and wants to do it, support her to get it done.  Nobody wants to squeeze a prolapsed bladder/uterus!  I am sure with it hanging out, it's creating many issues... :-(   I agree with the other posters that she needs to have all of her paperwork in order for medical and financial POA so that you and/or her son can manage things like this.

Best of luck.

A urogynecologist may have other options if her pulmonologist doesn’t think she can handle the surgery. I would seek out this specialist.

I am an RN and have worked in OB/Gyn. It sounds like she definitely needs surgery at this point. The surgery is not complicated but your concerns are valid. I would ask the surgeon to let you talk to her anesthesiologist for his/her recommendations.

I don't advocate for a "general" since she would have a more difficult time and might end up on a ventilator for awhile.

She might be able to have a "spinal" and she wouldn't feel anything during the procedure. She could receive meds to help her relax. It would be a bit more difficult given her anxiety, but "do-able".

She would need to be cleared for surgery from her usual physician and her breathing doctor. If there is a question of heart damage, she would need to be cleared by a cardiologist as well.

My mother has advanced COPD, dementia and a prolapsed uterus. Find a good Uro-gynecologist and have a pessary installed. This holds her bladder in place. It must be removed and cleaned every 3 months. My mom also has an estring placed above the pessary. This delivers estrogen and keeps her vaginal wall moist so the pessary is easier to remove, clean and replace. This works amazingly well and my mom has had few issues with it. It took a few tries to get the correct size as too small fell out and too large is hard to get in and out. I would insist on the estring as this helped tremendously. We apply for and receive this estring free each year through Pfizer. Since the prolapse leads to significant urinary tract infections without treatment, her dementia could go away. My mom’s is caused by the COPD and perhaps carbon monoxide from years of smoking so it didn’t go away, but your MIL’s doesn’t sound so severe.

After reading the other replies, I cannot emphasize enough to find a uro-gynecologist. Ob-gyn’s are generally not experienced in this problem, nor are urologists. We struggled with the wrong doctors for months before finding our uro-gyn. She was a God-send and has made all the difference in the world!

My MIL had this done at age 89. No problems at all and was a huge improvement over the pessart and having removed for cleaning etc. She was anxious and given appropriate medication for this.

Dear Mollymoose,

First, there’s no need to apologize for trying to do your best for a loved one!

I am a Health Care Advisor, also known as a Patient or Health Advocate. I am an ABD-Ph.D. in medical sociology and gerontology. My first piece of advice is to get a proper psychiatrist to treat your MIL’s anxiety. Buspar is a very old drug and not as effective as some newer ones. (The newer ones, can be habit forming so patients must be monitored - but are generally safe and more effective.) If her anxiety is as bad as you indicate it is, her PCP shouldn’t be prescribing her psycho active medication. In my opinion, PCPs, in general, should not prescribe psycho active drugs.

Once her anxiety (and COPD) is under control, you’ll be in a better position to make a decision regarding the surgery. Getting an appointment with a psychiatrist can take a long time. When you call, be sure to tell the office the circumstances (that surgery needs to be done ASAP). If you are a new patient you may get in sooner.

If you’d like to have a Health Advocate or Patient Advocate to work with you, Please Google “health care advocate”. There you will find a lot of useful information about medical advocacy.

I’d be happy to take your case myself, free of charge. Pjsardella56@gmail.com

You'll need a specialist and not just your typical ob/gyn. Ask the medical doctor for the correct dosage of medication.