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Alzheimer`s Disease/hip replacement w/Alzheimer's

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QUESTION: My husband is 63 and in late stages of Alzheimer's.  Both of his hips are fused and in need of replacement.  He is in a lot of pain.  His primary Dr. thinks he may live several years more because he's young, strong and no other health issues and therefore suggesting we go through with the surgery.  My questions are 1) do you feel the benefits will out weigh the consequences? 2)  Should we request and epidural or spinal for the surgery? 3) What will be done about keeping him from trying to get up before he's suppose to? 4) What kind of rehab will be expected with his Alzheimer's?

Thank you.

ANSWER: Hi Gloria-
First of all, let me say I feel for you since my wife went through an experience similar to your husband and I can identify with your situation.  The answers to several of your questions are better answered by someone with more of a medical background than I have, but here is my take on what you wrote.  
My wife was probably on a pre-school cognitive level when she entered a nursing home at age 60 and she didn't pass away until she was 69. I would be inclined to have the surgery done, but you also can request a second opinion before making a decision on that.  Most of your other questions would be best answered by staff at the nursing home if your husband isn't home or staff at the rehab facility he would go to after surgery.  You are right in being concerned about issues regarding rehab, etc. for someone in his condition.  On the other hand, it is likely that the present condition of your husband's hips must be the cause of considerable pain and while there will be pain following the surgery, this will hopefully go away.
Please feel free to send follow up questions, if I can help in any way.

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QUESTION: I put my husband in a private home with just 2 other patients just before Christmas.  The people running it said they're not sure they would put him through the surgery.  He's also on hospice for palliative care, not that we expect him to live less than 6 month.  They have given him Norco which is Tylenol with codeine and the people caring for him said it was too much for him to handle on top of his other medication.  Besides his Alzheimer's medication, he is on 200 mg of Celebrex twice a day.  I've added Tylenol arthritis and joint juice and it seems to be doing some good for now.  I'm sure that's not the cure all, however.  Since I last wrote I've had some input from nurses and Drs.  It's been suggested that he has been living with this pain for a long time so is familiar with it.  Introducing a new excruciating pain may confuse him and make him do strange things to try and escape it.  Also, I'm really concerned he will not ignore  any bandaging or drainage tubes.  I'm getting an opinion from another orthopedic surgeon, but although he's the best in the state, I still don't know that he will truly understand my husband's condition.  I also will be talking with a physical therapist re: what to expect with rehab.  Your comments would be appreciated.

Answer
Hi Gloria-
Once again, I want to stress my lack of a medical background.  However, based on your two sets of questions, I can see that you are very hesitant about going ahead with the surgery. The people who run the home that your husband is in also seem to have their doubts about the wisdom of going ahead with the surgery.  Therefore, I think you should not second guess yourself if you decide that you don't want the hip operation done right now.  It is my understanding that the pain after such an operation is pretty intense and those with AD are not good rehab prospects, so I can understand your deciding not to go ahead with the surgery.  Moreover, since you have your husband in hospice care, it seems like you are dealing with his probable loss in the relatively near future.  In such instance palliative care in the form of pain medication, which you have indicated he is receiving, may well be the better option.

Alzheimer`s Disease

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Peter Winkler

Expertise

I can answer questions regarding the care of persons with Alzheimer's Disease. I have no medical degree and I am not qualified to answer questions of a medical nature.

Experience

I was the spouse and primary caretaker of my wife, who was diagnosed with dementia at the age of 53. I initially cared for her at home, but after her illness progressed, I placed her in a long term care facility. A year later, I found a nursing home for her and she spent almost 10 years there before she passed away.

Education/Credentials
I have an MSW (Master's in Social Work) degree.

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