Evelyn Cotter was 92 when she was told that she had colon cancer and needed life-saving surgery
Evelyn Cotter was 92 when she was told that she had colon cancer and needed life-saving surgery.
However, it seemed that the operation would not go ahead if the former teacher did not pass a pre-operative fitness test, including ten minutes of pedaling on an exercise bike. "I was out of breath after four minutes," said Evelyn, 94, from Llanishen, near Cardiff. The anaesthesiologist was adamant that it was not safe to continue with the operation.
But Evelyn was ready to fight back. At home, with the support of her daughter, Mairiona, 69, she started walking through her garden while the kettle was boiling, extending the circuit four times a day. She also started breathing deeper and held each breath for 25 seconds.
After just eight weeks, she returned to the University Hospital of Wales in Cardiff and passed the fitness test with flying colors. She was subsequently operated on in 2017 and recovered with improved health in general. "I have picked up my amateur painting again and have just won a prize for my embroidery," says Evelyn. "I still drive and love gardening."
As our population ages, the age of ten million patients who undergo surgery in the NHS is rising faster. The average age in England is 40, but for surgical patients it is 54, the British Journal of Surgery reported in May. Eight out of every 100 Britons are now over 75, but they are good for one in four operations. However, it can be difficult to make a decision about surgery for the elderly.
The more birthdays you have had, the riskier the operation can be.
Common health problems related to aging, such as high blood pressure, clogged blood vessels, and heart and lung diseases, put the elderly at an increased risk of dangerous and potentially fatal complications such as bleeding or infections during or after surgery.
Now researchers in Canada have identified a new risk. As The Lancet reported in August, one in 14 surgical patients older than 65 is at risk of a & # 39; secret & # 39; or & # 39; silent & # 39; stroke – where a clot briefly reduces blood flow to a part of the brain that does not control obvious functions and therefore should not cause symptoms.
However, the impact – detectable on an MRI scan – a year later can lead to measurable cognitive decline, often with depression, memory and concentration problems and an increased risk of dementia and a serious stroke.
"Surgeons are now able to operate on older and sicker patients and, despite the benefits it brings, we need to understand the risks," said Marko Mrkobrada, professor of medicine at the University of Western Ontario. , Canada.
Meanwhile, one in 200 patients over the age of 65 suffer from a perioperative stroke – during or immediately after surgery – if it causes or worsens a weakness in a blood vessel that feeds the brain.
At home, with the support of her daughter, Mairiona, 69, she started walking through her garden while the kettle was boiling, extending the circuit four times a day. Pictured: Evelyn with her daughter Mairiona in 2016
A large study of 2,000 elderly patients undergoing surgery, published last month in the British Journal of Anesthesia, suggests that exposure to anesthesia after the age of 70 involves long-term changes in brain function, including subtle decline in memory and thinking skills & # 39 ;, such as the principal investigator, Dr. Juraj Sprung, an anaesthesiologist from the Mayo Clinic in the US, stated. But the jury is still not informed.
"The exact mechanism that causes this change in cognition is not well understood," said James Pickett, head of research at the Alzheimer charity. "Some studies suggest that this is due to surgery, while other studies indicate anesthesia."
There is some evidence of concentration and memory problems may be due to disorientation of hospitalization. The American Society of Anesthesiologists advised family members last year that they could help patients' rehabilitation by taking family photos, a clock, and a calendar to help patients return to normal.
But how can the UK best ensure that older people undergo a safe operation when they need it?
Five years ago, the NHS spoke out against age discrimination after evidence that up to 14,000 elderly patients died each year because they were refused surgery. "You should never stop age to undergo surgery," says Dr. Jonathan Hewitt, a stroke specialist at the Aneurin Bevan University Health Board in Cardiff.
A top priority for successful surgery in old age is the involvement of a number of health professionals – particularly specialists in this age group – rather than simply providing care by surgeons with support for anesthesia and nursing. Dr. Hewitt is a member of the Older Persons Surgical Outcomes Collaboration (OPSOC), a newly established international group of surgeons, geriatricians and statisticians who want to bring various health professionals together to improve surgical care for the elderly.
It is also recognized that older patients should have a voice, explains Dr. Mike Swart, a consultant in anesthesia and intensive care medicine at Torbay Hospital and the clinical leadership of the Royal College of Anesthetists for perioperative medicine, because they are often focus on something that may not be a real risk. "If you've had a stroke before, that can be the biggest concern, even if there's not much risk statistically," he says.
After just eight weeks, Evelyn returned to the University Hospital of Wales in Cardiff and passed the fitness test with flying colors
Simon Pillinger was diagnosed with colon cancer two years ago at the age of 63, but had the impression that the first surgeon he saw had little interest in what was important to him.
He felt that the surgeon was twisting it & # 39; was in an operation that could damage his sex life and leave him with a permanent colostomy bag. "He wanted to carry out the operation in his own way, regardless of its impact on me," says the former Weston-super-Mare police officer.
He asked for a second opinion and was referred to Kathryn McCarthy. The colorectal surgeon consultant at North Bristol NHS Trust opted for a completely different approach. They discussed Simon's choices and decided to opt for a nerve-sparing operation that would prevent incontinence and loss of sexual function, and with a temporary colostomy bag.
In a breakthrough peri-operative clinic at Torbay Hospital in Devon, high-risk elderly patients receive a one-to-one one-to-one consultation with senior clinicians who help with patient decision making.
In the future, an important new study will examine the impact on elderly patients of a decision not to perform surgery for any reason.
At the moment, the way fitness is defined varies, and that needs to change, says Susan Moug, a colorectal surgeon consultant and clinical associate professor at the University of Glasgow.
New evidence confirms, not surprisingly, that it is not age itself, but how vulnerable a person is who determines the response to surgery.
In a study published in the magazine Age and Aging in February, British researchers followed 2,279 surgical emergencies in children under 40 to 80 years of age. They reported that the more vulnerable the patient was, the greater the chance that they died, regardless of age.
But surgery is not for every older person, including those with early signs of dementia whose disease can be exacerbated by the anesthesia or the surgery itself.
"A person with a moderately painful hip who is referred for an operation with early dementia may need to consider whether they can manage without the operation if the pain can be treated in another way," says Dr. Swart.
In particular, surgeon Kathryn McCarthy adds: “We need to make patients aware of what is involved in an operation so that they can make an informed decision about the risks versus benefits and # 39 ;.
UNDER THE WEATHER
The health problems have been exacerbated by cold weather. This week: vote
About one in 15 people in the UK say their mood is seriously affected between September and April as the days get shorter and darker.
It is thought that lack of light makes an important contribution to the winter mood. & # 39; In particular, the lack of morning light in the winter can affect our mood, alertness and how long it takes to dispel the dingy feeling we have when we wake up (so-called sleep inertia) & # 39 ;, says Victoria Revel , a chronobiologist at the University of Surrey.
"It is therefore very important to get clear light when you wake up and during the day in the winter. Light upon waking keeps your body clock under control. If you use a light box at your desk during the day, you can maintain your energy, mood and alertness during the day; just like coming out outside. & # 39;
Medical breakthroughs that started on the battlefield. This week: Chemotherapy (stock image)
Medical breakthroughs that started on the battlefield. This week: chemotherapy
It has been the mainstay of cancer treatment since the 1950s, but the first form of chemotherapy was based on deadly mustard gas.
In the trenches of the First World War, this chemical weapon killed tens of thousands of soldiers by suffocation caused by blisters, the gas caused in their throats and lungs.
Scientists from Yale University in the US later discovered that mustard gas also seemed to kill white blood cells, cells that fight infections produced in bone marrow.
Scientists wondered if it could do the same with cancer cells and in 1942 tested it on a man with lymphomas.
He got nitrogen mustard, the substance used to make mustard gas and the tumors shrank.
Scientists later developed safer, more effective chemotherapy drugs, although they still have unpleasant side effects.
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