<p>Rob, that’s a tough one. My dad had AAA 10 or 15 years ago, before his health deteriorated so it wasn’t a tough call. At the time, we were told that it was a dire condition and had to be fixed.</p>
<p>I’m not sure what I’d do now. I guess I’d ask the doctor to explain the risks of surgery versus no surgery, in a big-picture way. Sometimes doctors are so focused on the medical problem at hand that they don’t think enough about how their “cure” will affect other areas of the patient’s life and health. </p>
<p>In the end, I usually go with the doctor’s recommendation even if it’s risky. I figure they’re more expert than I am. Plus, if I went against the doctor’s advice and then something awful happened, that would be hard to live with.</p>
<p>Travelnut, worknprogress & LasMa: thanks for the input. That’s the kind of “been there” info I was looking for. Mom’s attitude about most things now (and really for 82, she’s doing pretty good) is that people are living too long & nobody’s cutting her open. From what I understand it’s a 90% mortality rate when it ruptures, but the studies they’ve done for death rates/longevity for those who opt for surgery vs. those who don’t is only about 7% different from one to the other. My bigger concern is: does this change how we think about her living situation? I know it won’t change how SHE thinks about it but it makes me a little more concerned. Especially since she insists on wedging a piece of wood behind her front door for “security.” May have to revisit that argument ;)</p>
<p>I figure her geriatric specialist, hematologist & cardiologist will all chat and weigh in. Considering they wanted her in a surgical setting to extract 6 teeth due to the uncertainty of what would happen because of her bleeding condition, I think the recommendation will just be to watch with ultrasounds every few months. She’s a tough old bird and I can’t imagine that she’d agree to have anything surgical done. Heck, she lies to them about taking her meds (but they know that.)</p>
<p>Then 77 year old Father had an AAA repaired surgically in 2008. The surgery was a success (he traveled from HI to Houston TX for the operation), but the recovery was a disaster! He spent 3-4 months in skilled nursing facilities as he battled infections, other complications, etc. and it took him a whole year before he fully regained his senses.</p>
<p>He now has another AAA–the HI doctor thinks he needs an operation. The Houston doctor thinks that the AAA needs to get worse than it is now before it makes sense to operate. I’m with the Houston doctor. Actually, I don’t want to see an operation at all. My concern is that my father’s health will deteriorate even more so that he will be bedridden and need more care than an assisted living place can offer. At this age, every major operation takes away some quality of life and he has precious little quality of life left!</p>
<p>We have a family history of AAA…my uncle had one that he refused to let the doctors operate on. He died of lung cancer before the AAA caused a problem. My aunt died of a ruptured undiagnosed AAA.</p>
<p>This is never an easy decision. Does your mom smoke? Is she diabetic? Elderly patients never seem to tolerate long exposure to anesthesia. The surgery has enormous risk factors, especially due to her age, CAD and hematologic disorder. It will also require an extended stay in rehab. If the AAA is less than 5.4 centimeters, some MD’s will recommend a “watch and see” approach along with statins, ACE inhibitors and doxycycline. My father-in-law never fully recovered from his surgery, with multiple complications, including a defective mesh device and changes in mental status. I would seek other opinions and ask specific questions about how the surgery will be performed, outcomes based upon your mom’s profile, etc. Best of luck to you both.</p>
<p>Actually, I think this is a healthy attitude and it certainly makes it easier for you and probably for her in the end. My parents are the opposite; they want every treatment/surgery/medication they can get their hands on. </p>
<p>As far as your Mom’s living situation, I don’t know that the AAA diagnosis itself would change that. But do you have other concerns about her living on her own? (I’m assuming that’s the situation now.)</p>
<p>Hello everyone. Just thought I would check back in and let you know how mom is doing. Mom had lost 50 pounds btwn April and august. One of the many doctor appts was the hematologist who ended up admitting her to the hospital. This turned into a blessing, after numerous tests and an upper gi the doctors found massive ulcers in her stomach. Nothing cancerous and the drugs they put her on worked. The followup gi found the ulcers have disappeared.</p>
<p>Her primary care doctor is another thing. He took her off her diabetes pills in July since her A1C was at 5.9. He didn’t check her a1c in October, nor did he weigh her and also took her off her anti-inflammation pills due to the ulcers. Argh. Both my mom and husband didn’t see anything wrong with his actions. Double argh.</p>
<p>I made an appt and took mom to another primary care doctor to get another opinion. She at least had her blood drawn. I liked the new doctor but mom is holding back. They will call me with the lab results this week. They also weighed mom, she has finally gained 5 pounds.</p>
<p>Mom is still having trouble walking sharp pains in her rt thigh. Its keeping her wheelchair bound which means she’s not driving. Both hubby and I are thinking that while the wheelchair is bad, mom not driving is good. </p>
<p>I have also noticed her handwriting has gotten a lot worse, it used to be beautiful and flowing and now its disjointed and halting- if that makes sense. Has anyone else noticed this with their parents?</p>
<p>Another question is should I override mom and continue to take her to the new doctor or just continue with her old one?</p>
<p>Thanks again, its nice to know there are people who’ve ‘been there, done that’.</p>
<p>My mom is “already” on statins although I use the term lightly. She has a number of meds she’s supposed to take and since I’m her only ride, I know that the Rx’s that are supposed to last 30 days last 6 months. I’ve tattled on her to the doctors and she gets mad but I’ve told her it’s better for the drs to know she’s not taking the full dose than think she is and wonder about the bloodwork. She doesn’t really “believe” in taking medication and tells me that she’s taking them even if she’s taking it 2x/week vs. the 4x/day she’s supposed to. So any new meds in the arsenal will be filled and taken at will. </p>
<p>Mom smoked for 60 years; quit 11 years ago. What I’ve read says 90% of people with AAA are/were smokers. Bingo. </p>
<p>As for the living situation, she’s in her own apt., 7 miles from my home. I talk to her every day. She’s fine mostly, but I’d love to see her in a residential senior community with meals & housekeeping included. She won’t consider it because she doesn’t want to eat on somebody else’s schedule. Which I get. But if she’s truly got a ticking time bomb, it would make me feel better if she was around more people. But this isn’t about me, it’s about her. </p>
<p>I really appreciate everyone’s candor about the post surgical recovery period. I think my mom would shoot down the surgery option even if all of her doctors recommended it, and it’s probably for the best. She was a great rehab patient post stroke because she had something to overcome & there was no pain. Post-surgery rehab is a different type of recovery. </p>
<p>Chuckle: so sorry that you’re having to deal with dueling doctors. I can’t believe he didn’t follow up with the A1C. I’d override mom about the doc, unless it would cause too much friction. Glad to hear that she’s gaining some weight!</p>
<p>Chuckle, my mom’s handwriting got very bad for a couple years before she died. She noticed it - was frustrated at hard it was to write and how hard it was to read her own writing. She marked this as one of the strongest indications that she was “losing” her abilities. She was firmly aware that she was losing ground mentally. The other thing she noticed was she could no longer add numbers properly. Handwriting and numbers. She had done all the detailed accounting for the family and losing that ability was tough for her. It was a few weeks after she asked me to take over her book keeping that she fell and broke her hip and landed in the hospital and thence hospice and on to her next adventure in heaven.</p>
<p>Chuckle, my mother’s handwriting also declined in her later years. For her, it wasn’t part of a cognitive problem, but a reflection of how unsteady physically she had become, with several falls, severe arthritis and “shakiness”. It was quite aggravating to her, as it occurred several years before she would have stopped being able to correspond otherwise. </p>
<p>RobD- Re: your mother living alone-I would be more concerned about the inability to manage daily routines and medications safely and consistently than the possibility of a triple A rupture. That is because even when my mother lived in a medical setting 24/7, there was no stated expectation that they could intervene effectively if the aneurysm ruptured. As surgery couldn’t happen, I had to put that in a separate category- an aspect of her health that I could have zero impact on no matter what. I then focussed on what could matter to her quality of life and “healthy” longevity in other ways. YMMV and every circumstance is indeed different. </p>
<p>My mother lived a couple of years with a terminal illness and her physicians’ take on the triple A was to leave it be and at times, I thought it was an perceived by them as a better alternative to what she could be facing as the illness played out. That said, the illness did progress, she had more quality time than we dared to hope for and all worked out with much dignity/peace. Good luck with this- it is such a juggling act and without a crystal ball there are ways in which we all navigate in the dark.</p>
<p>Chuckle- sorry for what you have all been through this year. It seems imperative that your mother have appropriate monitoring. If not seeing the original primary care dr. is ruining your relationship with her and that dr. is “okay” otherwise (perhaps a stretch here), you could consider having another dr. or specialist monitor the diabetes and seeing the original for the most routine stuff. Not practical or desirable in many ways, but with determined elders, you sometimes have to negotiate, compromise and pick your spots. All the best.</p>
<p>My Auntie was diagnosed with an AAA in her late 70s, they did not want to operate, I have no clue the sizes, but there would have been regular check ups. She collapsed one day, probably after having it for several years, luckily before the family left in the morning so she was seen collapsing. She went immediately into surgery and it was successful. The doctor said it was the ONLY time he had ever done the procedure on a live person. I guess they always do the surgery when they can, even if there is no hope, so that they will have the experience. She was the only patient he had had live. She lived another 10-15 years.</p>
<p>Hers did not rupture catastrophically, but just leaked badly, that is why she lived. On living arrangements, I think unless someone actually sees the person go down, there is not enough time to save them, and even that is marginal odds at best.</p>
<p>That is quite a remarkable situation and outcome, somemom. Great that she had all those years afterwards. It just goes to show you that for every “sure” thing, there is an exception. I never knew there was the possibility of a leak vs. a rupture.<br>
Thanks for passing that on to us.</p>
<p>My mom had problems with her handwriting before she passed away as well. I think it was legible although it got smaller and smaller and smaller until you would have to use a magnifying glass to try to decipher what she had writtten.</p>
<p>The H of a friend went down with a ruptured AAA while at the bank. They got him immediately to a hospital and operated, but he suffered some brain damage. He went from a guy who lived a normal life to a guy who could no longer communicate and walk. I think he would rather that no one save him. Great result for somemom’s mother!!</p>
<p>I just wrote an email this morning to the siblings that the money is running out and we will be looking for a Medicaid facility. I did this because Mom has been asking to change doctors. She has stayed with the same doctor when she moved to the skilled care facility because that doctor also has patients there, but it seems she has not seen her old doctor as frequently as she has at the other place. I’ve inquired about this, and the nurses have said that her doctor has charted in her chart, but perhaps either Mom has been asleep or forgets that she’s come ( a distinct possibility). Anyway, she has this attitude that she wants what everyone else has. She wants their meal, even though she chose another meal choice, and now she wants their doctor, even though she already has one. As this has been Mom’s new “bee in her bonnet”, I told the siblings we had to wait on changing doctors as I had to make sure the new doctor would take Medicaid, as Mom will have to go on that soon. I’m sure they will not like hearing this, as they like to “ask Mom for money” frequently, and the fact that the bank will now be closed will be distressing for them.</p>
<p>I do have a question about the “look back” period. If Mom does go on Medicaid, and the government decides money has to be paid back that had been gifts within the period, who pays that money back, Mom (no funds), her estate (us when she dies), or the individuals who received the gifts? I’m hoping the last scenario, as I’ve never gotten a gift, and I sure would hate to have to pay back money that my siblings got over the years, while I was the one who tightened her belt and sent her son to a less expensive college, as I didn’t want to take money from a wheelchair bound lady in a nursing home. Others had a little less scruples and a lot less willingness to modify their lifestyles to fit their income. Sorry, had to vent there, in preparation for the oncoming storm.</p>
<p>Here’s one site that talks about the penalty. It doesn’t specifically say WHO pays, it just says a penalty will apply & how to handle the penalty is up to the indigent client. I am sure there are other websites also dealing with this issue but none of them that I’m aware SAY where the money is to come from, as that isn’t the duty of the rules. In theory, yes, it sounds like it SHOULD come from whomever got “gifts” from the indigent but in reality such funds are probably long since spent, as you point out.</p>
<p>Sounds like the penalty is not monetary (that is, the money needs to be replaced), but that it will delay the applicant’s eligibility to qualify for benefits by months (if not years).</p>
<p>I believe ellemenope is correct about the penalty just delaying when she would become eligible for Medicaid. It would therefore be you and your siblings’ responsiblity to figure out who would pay and how until she became eligible for Medicaid. It’s good that you’re starting the conversation about all this with your siblings now.</p>
<p>I just remembered, when my Auntie went to the ER, her daughter told the Docs immediately about the AAA, they later said that was the only reason they knew what to do immediately and likely that knowledge saved her</p>
<p>As others have stated, my understanding is that the amount gifted within the legal look-back time frame is divided by a number that approximates the monthly nursing home fee and then for “x” number of months, the person is ineligible for payment. For example, if $50,000 was gifted within the look-back period and $5,000 is the current monthly Medicaid payment for nursing home care, than 10 months would be out-of-pocket. Do confer with an elder care attorney and or an accountant to be absolutely sure about all the details. There is a lot on the line and regs can vary or change. </p>
<p>For example, is every single dollar that is a gift included in the total or only large amounts? How do people handle it if nursing home care is imperative and large gifts are not liquid or available to the recipients for the initial payments? I have no experience with how this translates into actually caring for a frail elder. If a gift was used as a down payment on a house for example, what is the recipient’s obligation, if any? I could see this becoming quite challenging if recipients didn’t hang on to the asset in case it was needed on behalf of the person making the gift. </p>
<p>Even without the gifting issue, there are documents that need to be gathered for Medicaid eligibility and assessment. It is good to keep all bank records, accounts, etc. handy if this pending. </p>
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