Effects of elective surgery, anesthesia on MCI due to Lewy Body diseas

Posted by nelms @nelms, 6 days ago

My husband, 73, has MCI due to Lewy Body disease. He is a candidate for abdominal hernia repair surgery. He is currently physically active, and the risk of not repairing the hernia is (at least) a reduction in vigorous exercise, which has as much—or more—positive effect as the Adderal and Donepazil. He also has autonomic problems, including loss of smell and urinary incontinence, and I wonder if there may be risk to bowel function without repair. But, there is risk of MCI- related decline and adverse events with and after surgery and anesthesia. If we wait until the hernia is intolerable, he may be in a worse cognitive state, and cooperation, adverse events, and decline could be worse than if we did it now. There is also the issue of surgeon and anesthesiologist understanding risks and management due to MCI/LBD. Anybody have experience with this?

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My DW who also has LBD needed a colonoscopy and I found when talking to the anesthiologist that there are safe choices for LBD patients that don't have the risk of further cognitive damage. If the anesthesia folks aren't familiar with LBD they might need to do some research.

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My LO required surgery after his diagnosis of LBD. Propofal was used. He was confused for a short time. But if your husband needs surgery, discuss the anesthesia with your doctor. Otherwise stay away from hospitals.

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Thank you. I need to meet the anesthesiologist and see if he or she is familiar with LBD. I will also run this by our out-of-state neurologist, who I am sure will have guidance I can share with our docs for the surgery. I just need to be sure they are all on the same page about anesthesia and post-op care.

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@jan83404

My LO required surgery after his diagnosis of LBD. Propofal was used. He was confused for a short time. But if your husband needs surgery, discuss the anesthesia with your doctor. Otherwise stay away from hospitals.

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Thank you! How long was you LO confused?
And it sounds like you have had more hospital experience with your LO…? Any general advice?

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Boy, talking about having to be your own advocate. I don't think the physical therapy nurses we just had were that familiar with LBD.

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@nelms

Thank you. I need to meet the anesthesiologist and see if he or she is familiar with LBD. I will also run this by our out-of-state neurologist, who I am sure will have guidance I can share with our docs for the surgery. I just need to be sure they are all on the same page about anesthesia and post-op care.

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@nelms the fact that your LO is going to have surgery is only 1 part of the experience, You also need to be aware of, and plan for, how he will react concerning the whole experience of going to a new place, meeting new people, not having you right by his side, as well as surgery and feeling strange when he wakes up.. I’m not sure if he’ll go home after the surgery or spend the night. As a long time nurse, I cared for many, many patients just like your LO. Talk to as many hospital personnel as you can and maybe take him to lunch in the cafeteria. But that might be too confusing with all the noise and hustle-bustle. When is the surgery scheduled for? Maybe I can find a good article for you. I’ll be thinking of you.

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For all members who are caring for someone with dementia:
This article has great information on anesthesia/medicines/hospitalization/dementia.
https://memory.ucsf.edu/treatments-stays/surgery-hospitalization/anesthesia
This article is aimed at the caregiver.
https://www.caregiver.org/resource/questions-to-ask-when-considering-surgery-for-a-person-with-dementia/
I hope this information will help everyone!
What is one question or concern you wish the article had covered?

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Thank you!
And in reply to your prior response, my husband is still a (usually) well-functioning MCI due-to-Lewy-Bodies person. He will not be confused going into a surgery or hospitalization, but I am concerned the surgery, pain, and anesthesia might push him into a lower functioning state. I have read that potential responses for surgical patients with Lewy Body disease differ from those related to other causes, such as Alzheimer’s. I figure I would need to be there to distinguish between LBD-related RBD and delirium, which could happen post op with any MCI or dementia. As a long time nurse, did you observe anything like this?

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@nelms

Thank you!
And in reply to your prior response, my husband is still a (usually) well-functioning MCI due-to-Lewy-Bodies person. He will not be confused going into a surgery or hospitalization, but I am concerned the surgery, pain, and anesthesia might push him into a lower functioning state. I have read that potential responses for surgical patients with Lewy Body disease differ from those related to other causes, such as Alzheimer’s. I figure I would need to be there to distinguish between LBD-related RBD and delirium, which could happen post op with any MCI or dementia. As a long time nurse, did you observe anything like this?

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Whatever you do, if your spouse needs to stay overnight, don't leave. Sleep in the chair no matter how many nights it is. After two nights in the ER, I went home to sleep after my husband's Pacemaker surgery. He had not yet been diagnosed with ALZ. I had never heard of hospital delirium, until the nurse called and told me that my husband had to be restrained and sedated; security had been called in. WHAT! Surely, they couldn't be talking about my husband. He had a total melt down and tried to bite, hit, rip down the curtains and escape. He had to stay another night. The nurses were so appreciative of my sleeping in the chair which kept him calm. It was yet another step in my learning curve on the road to ALZ.

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Wow. I am so sorry! Steep learning curve. Did your husband recover to his pre-surgery mental state? Or, did he lose some cognitive function that never came back, even after he was home?

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