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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Medical
Satisfied Customers: 8999
Experience:  Neurologist/Internist with academic and clinical experience.
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IN 1992, my husband had a double bypass and then got a

Customer Question

IN 1992, my husband had a double bypass and then got a Pacemaker. The battery lasted 12 years so of course, the second set of wires went in over the first. Last year, a part of his Pacemaker failed. The dr. waited to see if perhaps he didn't need that particular wire. He did. Meanwhile, we were in a terrible auto accident. My husband lost about 50 lbs and had become frail. Because of the double set of wires in my husband's chest, he would have to have surgery to have them removed. His heart (and I'm not exactly sure what this means) was (where the wire to his heart failed) 40/30. The doctor said that because my husband was frail, she would not even attempt such a surgery (even if he was sent from where we live in WV to Pittsburgh's med center). Meanwhile, of course, that 40/30 has got to be going down (I have some understanding of it). I know I won't have him much longer. My question is: if he were able to regain the weight, would he be a candidate for the necessary surgery. He's 90 years old and. as a result of the wreck, has dementia. I know the real question is one of kindness...would I REALLY want him to have the surgery when his mind is failing? I'd want him to if making his heart better would give him more energy and possibly help his mind. I notice that oxygen at night helps him considerably and he WANTS to do things. He was out in the yard yesterday clearing up winter's debris. He's lucid most of the time, and had a fine mind (lifelong newspaper editor). But aside from all that and just for my info, would the weight gain make him a candidate for the surgery?
Submitted: 10 months ago.
Category: Medical
Expert:  Dr. Frank replied 10 months ago.

Hello. Welcome to JA. There is no question that gaining weight, or moreover, strengthening his upper body/chest wall would help him be a better surgical candidate. Has he had any of the presurgical evaluation looking at his pulmonary function (perfusion CT scan, or V/Q scan)? Looking at his blood work, what is his albumin level and total protein level? What is his renal clearance (CCL)? These figures would determine his eligibility for surgery. I cannot tell you without looking at his cardiac studies what his potential for improvement is with surgery, if you have any of those studies, you can upload them leaving off his name, as this is a public forum. I will then give you a response based on his numbers. Dementia by itself is not an exclusion for surgery, if that is your question. It could be the dementia is a vascular dementia, related to the same condition that is reducing his heart function. If that is the case, and this is not Alzheimer's Dementia, then increasing his coronary perfusion and cardiac output may help his overall mental status, much as you see when using oxygen. Please get back to me with questions and/or more information, and we can discuss this until you are satisfied. Or if satisfied with this answer, please remember to rate this service by clicking on the rating stars, as that is how I am compensated for this work thanks *****

Customer: replied 10 months ago.
You answered, "Dementia by itself is not an exclusion for surgery, if that is your question. It could be the dementia is a vascular dementia, related to the same condition that is reducing his heart function. If that is the case, and this is not Alzheimer's Dementia, then increasing his coronary perfusion and cardiac output may help his overall mental status, much as you see when using oxygen." This encapsulated what I was thinking or more to the point, wondering. I'll try to get the information you wanted and get back to you early next week. Thank you.
Expert:  Dr. Frank replied 10 months ago.
Hi yes please get back to me and we can discuss possibilities. Dr Frank
Customer: replied 10 months ago.
I did reply to your response; maybe I forgot to "send." I said thank you and I'd get the information you need if I can and send it within the next couple of days. However, I've had time to think about it and doubt that I can get the info. At any rate, you've told me what I wanted to know -- that the possibility exists for my husband to have the needed surgery if he were to regain his weight. I think that is not going to happen. He eats fairly well and loves candy for snacks (at his age, I give him what he wants) but he hasn't gained an ounce. He's attempted to do a little work outside (we have a farm) just doesn't have the energy to do it so I encourage him to just sit in the sunshine and enjoy. He's appears to be much better mentally since I brought him home from the nursing facility but still believes his very vivid dreams. So again, thank you for your response. I may update you after we see the cardiologist if anything changes.
It doesn't look positive and it's really too bad -- he's a good and intelligent man. Peggy
Expert:  Dr. Frank replied 10 months ago.

These are decisions coming from within, you have known him and his situation better than anyone else. If you need suggestions, please get back to me and I will reply. Dr frank