Mrs. D came in yesterday for her four month checkup. She just saw her vascular surgeon within the last month and had some questions....
She was the full-time caregiver for her husband until his Alzheimer's disease got to much for her. She was 88 years old when she thought she "gave up" and moved her husband into the nursing home. "I don't think you gave up," I said to her back then. "You're not exactly a spring chicken anymore and he's more than twice your weight. I have no idea how you've been able to take care of him at home by yourself for such a long time."
The other reason she had to place him in a nursing home was that she required surgery to repair an abdominal aortic aneurysm. In addition to recuperating from the surgery, one important restriction she had was absolutely no heavy lifting -- like of her husband when he would fall on the floor at home.
Her husband died peacefully a few months later. A couple of Mrs. D's children moved back to the area to help sell the house and take care of the legal affairs. They all live in the same house here now.
Oh yeah, did I mention that this was the only surgery that she ever had and currently is on no prescription medicines. It's not because she refuses to take medicines, it's because she's THAT healthy and is still very independent.
...."My doctor told me I need an MRA. What's that?" Mrs. D's doctor initially ordered a carotid ultrasound to check for blockages. The findings were questionable, so an MRA was recommended to get more information. I explained what an MRA was and if there was significant blockages, then surgery could be done to repair it.
"Do you really think I need an MRA? I really don't want anymore surgery. If I was your grandmother, what would you say?" This is probably one of my least favorite questions in all of medicine. Usually, I put my lawyer hat on and give a laundry list of potential problems if a critical stenosis is not diagnosed or treated.
"If you were my grandmother, I'd say that you've been getting along for almost your entire life without the need for medications and doctors. Whatever you decide is probably as good or better than anything I would say. I mean, hey, you're healthier than I am. I should be taking health tips from you."
"Well, I think I'll leave things be. You don't think that nice young man," she meant her vascular surgeon, "would be mad at me if I cancelled the MRA." "No, not at all. I think that he'll understand." "Well, then it's settled." "I think it is."