Docs: To Fix or Not to Fix -- a Poll

In My Humble Opinion
1

So, Mom_Crayons is taking a poll about whether or not she should fix this hole in her heart. Doctors are happy either way.

The background:
There is a congenital defect that occasionally occurs. As a foetus develops, there’s a tubes going into the heart. Foetues gets a bit more developed, the tube pops out, hole closes shut, and baby is born with a good little ticker. Sometimes babies are born whose hearts haven’t sealed the hole – no biggy, baby gets a quick fix. All is well.

Somehow, Mom_Crayons went through her entire life without anyone noticing she had this big, honkin’ hole in heart. She was captain of her highschool basketball team (all 5’2" of her snort!) and did lots of track and field. She’s been a fairly active lady, though not so athletically inclined as an adult.

Once upon a time, someone noticed a heart murmur, but a few years later she seemed to have “grown out of it.” Then a couple of years ago, during a routine physical the doc said “Hey, your heart murmur is back! Hm. It’s awfully loud…”

So lo’ – now approaching 70 they’ve discovered that all this time she’s had that great big hole in her heart.

Three doctors and the specialist have all said the same thing:

“Well, if you were 30, I’d recommend fixing it because it might kill you at 50. But since you’re almost 70 and have never had even the slightest problem… Well, heck it’s up to you! If you want to fix it, we’ll fix it. If you want to leave well enough alone, that’s cool too.”

So now she’s not sure. Women in our family live until 95 easy (she does not want to live that long, she says). The docs have said “well, it could take about five years off your life or so…” which means she’ll drop off the perch at 85-90? She’s not really worried.

So what does everyone think:

Fix it? (It’s not a very invasive procedure.) or

Leave well enough alone.

Doctors are happy with either, and mom is equally ambivalent and can’t make up her mind.

WWDD? (What Would Dopers Do?)

2

I am not a doctor (of course there’s a disclaimer)

HOWEVER - if it hasn’t been a problem for 70 years I’d say it ain’t broke, and if it ain’t broke don’t fix it. If it were me, I’d say no to the surgery.

3

It sounds to me like the risks associated with the surgery (especially surgery on the elderly) outweigh the potential benefits. I’d skip the surgery.

4

Broom The disclaimer is appreciated, but not really necessary – the doctor’s genuinely feel that either decision would be perfectly sound. So I’m polling to see what other folks would do and non-docs are welcome to contribute.

I think my mom is inclined just to let it be because it’s been a non-issue, but then she’ll say: “…well, the surgery isn’t really invasive…”

It’s not like a bypass or anything, it’s not a complicated procedure. Still, it is heart surgery.

If it was me at my age the docs said they would recommend surgery because I could die young, but in my mom’s case, it clearly isn’t affecting her overall health – since she’s not dead already, they feel her body has been coping just swimmingly on its own.

They only recommend that if she goes to the dentist, she has to take anti-biotics for awile before hand – an infection could be dangerous.

5

Since you’re asking for opinions, I’ll give it. Be warned that I’m assuming her docs have done the appropriate tests and exams, and are truly fine with either decision. If so, I’d recommend skipping the surgery, but getting regular cardiac evaluations, so if things change, surgery could be considered quickly.

QtM, MD

6

As with any medical answer I post, this is not medical advice. You didn’t specifiy the defect, and though I can guess, I don’t think it matters here. Your general outline of the prognosis is plenty.

I can definitely see going either way, and my tendency would be to leave well enough alone. Though complications may be uncommon in this procedure, they are truly tragic when they occur. The first rule of the Hippocratic Oath is “Primum non nocere” or “first do no harm.”

For balance, however, I would gently ask any patient to consider that additional years can become increasingly precious as they grow older and have fewer years left. Also, the quality of those final years may be affected if her condition takes a turn for the worse. I wouldn’t make too big an issue of it -no point in creating anxiety- but I’d like to know they at least considered it -as well as one can consider it, given the many unknowns and sheer blind luck of the draw.

She might not be a candidate for surgery when she is older or sick, but that may not be a problem. Some would prefer to die a little sooner, enjoying life and most of the capacities of life as they knew it, while others would gratefully scrabble out a few more years -or even weeks- as an invalid.

**Perhaps the most important fact to keep in mind is this: whatever decision she makes will probably be irrelevant. ** Not knowing her exact family history and medical condition, I’d guess that it is more likely that she will die of something else: she still has a similar likelihood of dying of other causes, as she would have had without the defect. She might get hit by a bus, break a hip skydiving, or throw an embolus trying to do page 57 of the Kama Sutra. No matter how solid the actuarial figures, we are, each of us, just anecdotes.

Once she makes her choice, she should try to be glad she had an option, rather than worrying about it or second guessing it too much.

7

Also be aware that, from what I can tell, anethesia has a much more prolonged effect on the elderly. My grandmother had valve-replacement surgery and it took her months to get her short-term memory back, and she’s still suffering from memory loss she didn’t have before the surgery last summer. How long your mother would be out for this surgery, I don’t know - you might want to ask the doc that. But it sounds like she’d be fine without.

8

Surgery is no fun under any circumstances. If I was in your mother’s situation, I’d leave well enough alone, but keep an eye on things.

This reminds me of a Dr visit my husband’s grandmother had in her 90s. Her cholesterol was a bit elevated and they suggested she alter her diet.

She was in her 90s! Her health was OK otherwise. Why would a little old lady in her 90s suddenly have to fret over what she ate?

She was 96 or 97 when she died - I don’t think the cholesterol was responsible.

9

I personally would opt not to have the surgery. The risks of everything, it seems, increase with age. If she feels fine and is relatively good health otherwise, why bother?

10

Guess you can’t use indomethacin at this point to close the defect! I’d probably agree with Qadgop.

11

Thanks Qad. Yes, indeed she’s had a barrage of tests (echograms and whatnot), and has been thoroughly examined by a cardiologist, and she also gets her blood pressure checked weeky as well. They’ve all said that since she’s been always been so active and it’s never caused any problems, it isn’t really affecting her life or health.

Kinda funny – everyone was a little shocked since my mom has had extensive health exam work-ups prior to major surgery in the past – and never has anyone had the slightest inkling that there was a problem. Often there’s not even a murmur to be heard!

I think she’s inclined to leave well enough alone, BUT since they described the procedure in detail, and it appears to be relatively simple and non-evasive, she’s kind of mulling over the possibility, thinking, “well… maybe…”

KP the defect is a common one – I just can’t remember due to brain cramps – and it’s usually fixed during infancy.

There is no history of cancer, heart problems, diabetes, nothing on her side of the family. She doesn’t smoke, doesn’t drink, and eats way healthier than I ever could.

As mentioned in my OP – on that side of the family, they usually live to 95 (in fact 102 isn’t all that unusual). So she is expected to live for another 10-20 years. :eek: Most people who meet her think she’s about 55 and her friends have accused her of having a face-lift because she looks so much younger than they do. (Pfeh! I have more grey hair at 31 than she does!)

She is also planning on slowing down because her vision is failing, so it’s not like she’s planning to take up rock climbing, or extreme snowboarding. She lives a socially busy, but gentle lifestyle.

I’m inclined to say “leave it be” and I’m pretty sure that’s what she’s thinking too. So do all the nurses and doctors she used to work with.

Thanks a bunch, I’ll pass your opinions along.

12

A friend of mine jokes that if he lives to 75 he’s going to start a huge heroin habit – he figures “What’ve I got to lose? My health? May as well really enjoy my last few years!”

13

Just a bit of further info:

There are times when it’s NOT a quick fix and one’s kid sister dies on the table at age 2.

14

:frowning:

Didn’t mean to trivialize the severity. The idea of working on the heart of a wee one is positivley terrifying. In recent years (or so they’ve told us) this defect is fairly easy to repair. That is really the only reason my mom is even considering the option.

15

My mom had the same problem, and it was something they didn’t find until last year after a sizable stroke caused a lot of weakness on her left side. She has end-stage renal failure and her health is not stable (she’s currently in the hospital, and was in ICU and on a ventilator just last week), so I was kind of against her having the surgery, worrying that something would go wrong.

However, it was a simple, quick procedure, and they fixed the problem. She still had another stroke, but that was for a different reason. She’d always been rather sickly from babyhood on, and I think that was a possible cause. But at 56 and in increasingly failing health, she made it through the surgery with flying colors. :slight_smile:

16

What was the recovery time like?

Mom_Crayons hasn’t been sick at all. Never had any major health issues and her health today is about the same as it was when she was 40 – she doesn’t drive anymore so she’s getting slightly more exercise and since she isn’t retired, she’s a lot less tense (I’m sooooo jealous.) Basically, aside from her eyesight, she’s in superb shape. (Well, a little portly but we all develop a panda bear physique by the age of 35.)

The risk would probably be quite low for her, were not really worried. But since she is so healthy it seems odd to poke instruments into her.

Oh and how quick was “quick” when they did your mom’s?

17

Atrial septal defect, right?

My mother had open-heart surgery to repair that in September 1999 when she was 54 years old. It was diagnosed when she was a child and the doctors opted to leave well enough alone, but as the years went by and it had more of an effect on her health and general well-being, the decision was made to sew it up.

The procedure was relatively quick - not outpatient, certainly, but she only spent a few days in the hospital. Recovery took more time; she wasn’t out running marathons (or even just walking across a room) for a while after that.

18

EEno (sorry, couldn’t resist – I know it makes you grind your teeth, mwa-ha-ha-ha!) – it’s a similar defect called Patent Ductus Arteriosus. Atrial septal defects, IIRC, occur when there is a hole between two chambers. This is similar except that the shunting occurs outside the heart and not inside.

I guess this is why it’s a bit easier to fix. It’s my understanding that in many cases they can place “plugs” using catheters instead of cutting open her chest and heart. They aren’t planning any open heart surgery at all for my mom (should she opt for the correction.)

The thing is that there is a point where it’s gone on so long that plugging the hole doesn’t make a difference in the overall health of the patient anyway, because the condition induces changes in the arteries that get affected by the wonky pressure. (This can lead to Bad Things, but in my mom’s case it doesn’t appear to have.)

My mom’s body seems to have coped just fine on its own.

Hmm. More and more I’m thinking she outght to leave it alone.

19

This might be a different surgery than they’re considering for your mom, looking at Ino’s post. My mom’s was correctable via a catherization procedure. The whole thing took less than a half hour. Her leg was sore for a bit afterwards, but she was out of the hospital and back in physical therapy (for the aforementioned stroke) the next week.

If the procedure was to be done via catherization I’d opt for it (myself); if it’s open heart, that’d be a different matter.

20

Phoebestar – about 15 years ago or so, I got to go on a tour of a plant that makes teflon balloons and catheters for cardio angioplasty (in a nutshell: tube goes into a vein in your leg and is fed in all the way to your heart where a balloon inflates to help widen your arteries – waaaaay cool!)

I got to see a video that demonstrated the process. Absolutely fascinating! Somewhat nauseating, but fascinating!

Yes, it seems that my mom would not be getting open heart surgery but rather something much less intrusive.