Elective surgery

Newcomer introductions, personal anecdotes, caregiver issues, lab results, and n=1 experimentation.
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NikiB
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Elective surgery

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APOE4/4 status. I am 47 and have always had ridiculously large breasts for my frame (5’5”, 120 lbs, 32G). It has caused me both physical and emotional pain. I really want to get a breast reduction, so that I can exercise the way I want to, wear the clothes I want to, and rid myself of terrible upper back pain. What are your thoughts about going “under” for surgery? I found one physician who will do the surgery under local anesthesia, but she has poor ratings and every other doc refuses and says that it needs to be general. I will also likely need a hysterectomy at some point in the not too distant future. I have been under a few times - general for appendectomy, then the lighter sedation x 2 for D&C’s after miscarriages, once for wisdom teeth, once for colonoscopy, once for ganglion cyst. Would love your insight! Grateful for this community of intelligent, well educated folks!


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PeterM
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Re: Elective surgery

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NikiB wrote:APOE4/4 status. I am 47 and have always had ridiculously large breasts for my frame (5’5”, 120 lbs, 32G). It has caused me both physical and emotional pain. I really want to get a breast reduction, so that I can exercise the way I want to, wear the clothes I want to, and rid myself of terrible upper back pain. What are your thoughts about going “under” for surgery? I found one physician who will do the surgery under local anesthesia, but she has poor ratings and every other doc refuses and says that it needs to be general. I will also likely need a hysterectomy at some point in the not too distant future. I have been under a few times - general for appendectomy, then the lighter sedation x 2 for D&C’s after miscarriages, once for wisdom teeth, once for colonoscopy, once for ganglion cyst. Would love your insight! Grateful for this community of intelligent, well educated folks!

Hi Niki. Just use the ‘search’ feature (little magnifying glass icon) at top right of page to search for your answer. Enter ‘anesthesia’ and you will see several good threads on the topic of Apoe4 and anesthesia. Definitely fine tune your thinking but for the quality of life improvement you seek the trade-off is likely worth it. Especially at age 47. Good luck!


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NF52
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Re: Elective surgery

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NikiB wrote:APOE4/4 status. I am 47...I really want to get a breast reduction, so that I can exercise the way I want to, wear the clothes I want to, and rid myself of terrible upper back pain. What are your thoughts about going “under” for surgery? ... I will also likely need a hysterectomy at some point in the not too distant future. I have been under a few times - general for appendectomy, then the lighter sedation x 2 for D&C’s after miscarriages, once for wisdom teeth, once for colonoscopy, once for ganglion cyst. Would love your insight! Grateful for this community of intelligent, well educated folks!
Hi NikiB,

First let me offer an opinion as a woman: this is your decision; you alone get to decide how you want to spend the rest of your life. It sounds like exercise, being rid of back pain and improving your body image are all issues you have thought deeply about for a long time.
Exercise is one of the strongest recommendations for those of us with ApoE 4/4. This is from our Research Wiki: Recent Advances in Lifestyle Prevention
"A systematic review of 16 prospective studies concluded that physical activity decreased the risk of developing AD by 45%
  • Physically active ε4 carriers had an OR [odds ratio risk of Alzheimer's] of 2.30 and sedentary ε4 carriers had an OR of 5.53
    Aerobic activity was associated with greater cognitive performance for ε4 carriers compared to non-carriers)".
    Sedentary individuals who were ε4 carriers had significantly higher levels of brain Aβ and lower levels of CSF Aβ42 compared to sedentary non-carriers, findings associated with AD pathology
Dr. Isaacson notes that results of these studies with ApoE4 participants "... suggest that increasing physical activity... may have more pronounced effects in ε4 carriers compared to non-carriers. The findings also suggest that physical activity may prevent Aβ accumulation that occurs in the brains of ε4 carriers before clinical symptoms of AD even become apparent
Like you, I have had "light sedation" for a miscarriage, colonoscopies and bunion surgery. The times you've had light sedation have not been included in the studies of people with effects from general anesthesia, and seem unlikely to have any long-term effect that researchers measure. I've also had general anesthesia 4 times, from age 5 to age 63. While I have to have anti-nauseas drugs afterwards, I have never experienced a change in cognitive status, and tested with normal and stable cognition over a period of three years from 2017 to 2020 in a clinical trial.

Here's an excerpt from a 2019 peer-reviewed article on a large, population-based study in Oregon, with 1033 people who were followed for years both before and after surgery with general anesthesia. Like similar studies, these people had an average age of 78, so were at much higher risk of underlying risk factors aside from ApoE4:
Dementia assessments included the Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), and CDR sum of boxes. The battery of tests used in the neuropsychological analysis... assessed multiple cognitive domains and included ...executive function... attention and concentration, and... memory. The cognitive tests administered are standard, validated measures commonly used in longitudinal aging and dementia studies... Men with an APOE4 allele had more severe postoperative cognitive decline compared to women with an APOE4 allele. These findings suggest a potential explanation for the discordance in the literature regarding the relationship between postoperative cognitive decline and the APOE4 allele.
Sex and genetic differences in postoperative cognitive dysfunction: a longitudinal cohort analysis

If it were me, I would find the best-regarded surgeon I could, who has done lots of breast reductions and would be honest with him or her about seeking to avoid prolonged general anesthesia. But I wouldn't think of trying that level of surgery without general anesthesia.
Before having a hysterectomy, I would want to explore options for treating the underlying reasons for that, if they include fibroid cysts. If surgery is necessary, laparoscopy should make it a much shorter procedure than it used to be and an epidural may be possible which would leave our brain nicely awake. (I had epidurals for 2 C-sections, didn't mind at all being awake while someone was messing with my uterus! and recovered much faster than the one C-section when I was "under".)
4/4 and still an optimist!
NikiB
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Re: Elective surgery

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Thank you all for the input!! I really, really appreciate it. Lots to think about!!


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