Wait - A Four Letter Word for Seniors

The doc said, “Let’s wait and see how this develops” when I told him about the severe pains in my upper right abdomen, sometimes combined with vomiting. I also told him that I am the only one in my family member who hasn't had their gallbladder removed. It might be easy for the doc to wait – he’s not the one with episodes of pain and vomiting several times a year.

When Doctors Advise Wait and See, Worries can be Crippling, Scientific American (1)

A friend shared her own story about diverticulitis. Her doctor made her tough it out for three painful years before finally performing surgery that took out a significant chunk of her colon. We can't help but wonder if a speedier surgery would have spared her some agony. Plus, she could have enjoyed those three years without suffering.

The "wait and see" approach may make sense when you are in your 30s, 40s, 50s, or 60s, but it doesn’t make a lot of sense for seniors. Each year that ticks by makes our golden years less pleasurable and the risk of surgery higher.

We don’t have that many years left and we want to spend those remaining years as pain-free as we can. Besides, with the "wait and see" approach, we may be dead before the doc decides to do something. Hum – is that the plan? Is "wait and see" some sort of ageism? If I ignore it long enough, maybe the problem will go away.

Surgeries at our age can be dangerous. The longer we wait, the more our bodies deteriorate. There are horror stories about anesthesia killing brain cells which are already shrinking with age. But take heart, the Aging and the Brain paper says, “Dendritic sprouting may occur thus maintaining a similar number of synapses and compensating for any cell death.” (2) I’m so glad to know my dendrites are still sprouting.

Good to know my dendrites are sprouting

All kidding aside, surgery can be risky for people with heart issues or early-stage dementia. But that doesn’t explain the wait-and-see attitude for those of us who don’t.

So I consulted Dr. Google about the impact of anesthesia on the elderly. Big mistake. There were several studies, mostly conducted on elderly rats, jammed with medical jargon about the impact of anesthesia on older patients. After trying to read some of the jargon-filled articles, I decided maybe I'll wait until I reach 80 to delve deeper into these studies. By then my brain might have shrunk a bit, but hopefully, my sprouting dendrites will rescue me.

Diagram from a medical journal on the impact of anesthesia

Too complex for my brain (3)

After surgical anesthesia, some people of all ages suffer a “prolonged period of fuzzy thinking known as postoperative cognitive dysfunction (PCD)”(4) To reduce the risks of PCD, doctors recommend walking and making sure you wear your glasses and hearing aids if you need them. Duh! Of course, anyone would seem a bit fuzzy if they couldn't see or hear properly.

Hubby and some friends say they won’t have major elective surgery after 80. It’s easy for them to say, they already have artificial knees and hips. I still have my original knees and hips. What happens if my knees give out when I’m 85? Statistics show a lot of people are getting knees and hips replaced in their 80s and even their 90s. (5)

The good news is many of the medical journals I scanned recognize that surgery for people over 80 isn’t always bad. Most healthy 80 or 90-year-olds do not have to avoid surgeries that might improve their quality of life. The journals recommend doctors do an evaluation of total health before automatically ruling out a procedure based only on the patient’s age.

Whatever you do, don’t ask Dr. Ezekiel Emmanuel, a medical ethicist and Chief of the Department of Bioethics at the National Institutes of Health Clinical Center, about health care after age 75. He thinks we shouldn’t have any healthcare including vaccines or antibiotics. He says he doesn’t want to live past 75 and argues Life After 75 Is not Worth Living. (6) He bases his opinion on the fact that most big scientific discoveries are made by people younger than 65. So Dr. Emmanuel thinks the only value to life is scientific discovery.

Wait-and-see, isn’t limited to docs. We are all guilty of it. Sometimes wait and see is a good thing. If you have a minor injury, sometimes wait and see is the best tactic.

Other times, waiting too long can change your life. When we were deciding about whether or not to move into a Continuing Care Retirement Community, many of our friends thought they were too young. Unfortunately, the waiting meant that a couple of friends developed conditions that made them ineligible to move into a CCRC, so it’s no longer an option for them.

So, next time you are told "wait and see", ask yourself how the problem you are concerned about impacts your quality of life. Is it limiting or preventing activities that are fun and keep you healthy? Could it turn into a serious issue if left untreated? Does your family have a history of the same issue? It can be worthwhile to team up with Dr. Google and a specialist to determine if "wait and see" is the best strategy when our time for waiting and seeing is limited.

References

1. Charlotte Huff, When Doctors Advise "Wait and See," Worries can be Crippling, Scientific American, May 1, 2005

2. R. Peters, Aging and the Brain, National Institute of Health, National Library of Medicine, February 2006

3. Lingzhi Wu,1 Hailin Zhao,1 Hao Weng,2 and Daqing Ma, Lasting effects of general anesthetics on the brain in the young elderly: “mixed picture” of neurotoxicity, neuroprotection and cognitive impairment, National Institute of Health, National Library of Medicine, March 11, 2019

4. Judy F. Minkove, Think 75 Is Too Old to Have Surgery? Think Again., hopkinsmedicine.org, July 11, 2018

5. Hilal Maradit Kremers, MD, MSc, Prevalence of Total Hip and Knee Replacement in the United States, National Library of Medicine, January 1, 2020

6. A Doctor and Medical Ethicist Argues Life After 75 Is Not Worth Living, MIT Technology Review, August 21, 2018