Hi, love this forum. I haven’t done the genetic test yet, but daughter is APOE4 two copies. Sister also has two copies. Dementia and Alzheimer’s in both parents and grandparents, so it’s probable I’m a 4 with 2 copies.
I’m in my 60’s with a lot of health issues, diabetes, obesity, mood disorder, anxiety, depression and gut problems.
I’m about to get pelvic organ repair (stage4)including a bladder, rectal, etc. with hysterectomy, Fallopian tubes, no ovaries. Also doing an endoscopy in two weeks to consider removal of a lapband. ( probably delay surgery until the fall) I’m having a hard time getting clear answers to questions about the best neuroprotective anesthesia options to discuss with the anesthesiologist. It doesn’t look like I get to discuss this until the day of surgery and the specific anesthesia used in the past are not recorded on the patient records.
I also wanted to hear from other women who had the pelvic organ repairs and hysterectomy and what the outcome was...what anesthesia was used, and if they would opt for the same surgeries & anesthesia knowing the outcome.
I’d like to hear from those with gut issues after lapband and if there are any recommendations for lab tests to confirm my suspicions of leaky gut and if the lapband is causing inflammation, what tests and markers needs to be used. Seems the surgeons are always recommending surgery because that’s what they do.
This has been a difficult road to building optimal health, but I’ve come a long way with diet and lifestyle changes and starting the reCode program to be proactively fighting against getting AD. Perhaps an Admin can direct me to some discussions about anesthesia and surgeries mentioned above.
Newbie with surgery & anesthesia questions
Re: Newbie with surgery & anesthesia questions
Hi TWBD, and good for you to start tackling your health!
You can always use the search function on the site (the magnifying glass on the menu bar) to find out if we've already discussed a topic. We have a full thread on anesthesia. You can find the thread here.
You can always use the search function on the site (the magnifying glass on the menu bar) to find out if we've already discussed a topic. We have a full thread on anesthesia. You can find the thread here.
Re: Newbie with surgery & anesthesia questions
Welcome, TWBD!TWBD wrote:I’m having a hard time getting clear answers to questions about the best neuroprotective anesthesia options to discuss with the anesthesiologist. It doesn’t look like I get to discuss this until the day of surgery and the specific anesthesia used in the past are not recorded on the patient records.
I also wanted to hear from other women who had the pelvic organ repairs and hysterectomy and what the outcome was...what anesthesia was used, and if they would opt for the same surgeries & anesthesia knowing the outcome....
I was a songwriter in a past life ... makes me want to give it another go.
I saw your comment to a Teezer's post about his ApoE 4 news and had to quote that, along with your questions. I hope you soon feel like both singing and songwriting! We could use a great songwriter to put some of the truths of being in our 60's (I'm 66 and 4/4) into not just "Our Stories", but "Our Songs"!
I can't offer either medical advice or personal experience with pelvic organ repair. I did have a colon polyp removed with general anesthesia 3 years ago with no ill effects cognitively or otherwise, and have had 3 other surgeries with general anesthesia, from age 5 (tonsils) to my 30's (C-section). One of my Promethease reports confirmed what I already knew: that I am very prone to nausea after general anesthesia, so I now know to announce that and to advocate strongly for something stronger when the first line of anti-emetics doesn't work.
As for talking ahead of time: call up the surgery center and ask who the anesthesiologist will be and say "I need to talk to them at least one week ahead of time, not one day or one hour. Let them know I am a woman with Apoe 4 and I am concerned about post-operative cognitive dysfunction." Sometimes just using the big words gets their attention!
Here's a brief excerpt from a 2014 meta-analysis that looked at nine studies on the issue of POCD (post-operative cognitive dysfunction) specifically among people with Apoe 4.
Association between APOE epsilon 4 allele and postoperative cognitive dysfunction: a meta-analysis.
Cao L1, Wang K, Gu T, Du B, Song J.
https://www.ncbi.nlm.nih.gov/pubmed/?te ... poe+4+POCD
{emphasis added}Nine studies encompassing 1063 APOEε4 carriers and 2983 noncarriers were included. At about 1-week postsurgery, a significant association between APOEε4 and POCD was found (OR 1.83, 95% CI: 1.18-2.85), but the association was no longer significant after removing one large study (OR 1.35, 95% CI: 0.92-1.97). Stratified analysis of cardiac/vascular surgery patients also yielded no significant correlation (OR 1.62, 95% CI: 0.80-3.28). One to three months postsurgery, neither the overall analysis (OR 1.56, 95% CI: 0.87-2.81) nor the stratified analysis of cardiac/vascular surgery patients (OR 3.33, 95% CI: 0.55-20.22) indicated a significant correlation. APOEε4 was also not correlated with POCD at 1-year postsurgery (OR 1.15, 95% CI: 0.71-1.86). No evidence of publication bias was revealed by Egger's test
CONCLUSIONS:
The APOEε4 allele was associated with a significantly increased POCD risk about 1-week postsurgery, but the association depended on one large study. No association was found 1-3 months and 1-year postsurgery.
Here's another study, from 2016, following patients for up to 10 years post-surgery. The article is free, and has lots of charts for those wanting to dig deep.
The hopeful take-away is quoted below and summarized in the last sentence.
Cognitive decline in the elderly after surgery and anaesthesia: results from the Oxford Project to Investigate Memory and Ageing (OPTIMA) cohort
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5213281/
This comes with my warmest wishes that your surgery improves your quality of life tremendously, that you have support around you before, during and after surgery to reassure you that any symptoms will be transient (and to advocate for you with the hospital staff!) and that you will be singing songs and sharing your good news with us soon.The median age at recruitment was 72.6 years (IQR 66.6–77.8 years). APOEε4 allele heterozygosity was present in 117 and homozygosity in 14 participants.We found that elderly people were at risk of more rapid cognitive decline after an episode of moderate or major surgery with general or regional anaesthesia (Fig. (Fig.3).3). On further analysis, we discovered that in our cohort this effect was limited to those who had already suffered cognitive impairment (Fig. (Fig.4),4), that is, either mild cognitive impairment or possible or probable Alzheimer's disease. A second episode of such surgery reversed that decline at borderline significance (Tables 1 and 2). We found no difference between men and women. We found no independent influence of the APOEε4 allele on the effects of surgery.
4/4 and still an optimist!
Re: Newbie with surgery & anesthesia questions
Welcome TWBD! Congrats on all that you're doing to optimize health. I'm a 4/4 and have had very similar surgery and was able to avoid general anesthesia. Much of my experience is covered in Susan's link above. I ended up with both a spinal and epidural as the surgery was 3-4 hours in length. The epidural allowed the anesthesiologist to add additional medicine if the spinal wore off. I had a surgical drape by my head so I didn't see anything. I listened to a beautiful guided imagery audiotape for surgery (in the link above) to help me stay calm, plus I was given a small amount of yummy propofol.
I agree with NF52's suggestion. You MUST call the hospital several weeks ahead and ask for a lengthy meeting or phone call with the anesthesiologist who will be helping you that day. Explain your ApoE4 status and concern for your cognitive health. Ten minutes prior to surgery is not enough time for them to be prepared. I was the first patient to ever have both a spinal and epidural at my fairly large regional hospital. You can avoid general anesthesia. I found it very helpful to enlist the help and support of my surgeon. He fully supported my decision to avoid general anesthesia and guided the tenor of my overall treatment.
While I appreciate NF52's more hopeful studies, a broader look at the evidence demonstrates that E4s are especially vulnerable to some types of anesthesia. Print studies if you feel you need ammunition. I'm proud of you for being your own advocate and for putting your cognitive health first. You may be aware that you're about to undergo MAJOR surgery. I was pretty naive to that fact. Be prepared for a l-o-n-g recovery. Have lots of quiet projects, books, and movies to watch as you heal. -xo
I agree with NF52's suggestion. You MUST call the hospital several weeks ahead and ask for a lengthy meeting or phone call with the anesthesiologist who will be helping you that day. Explain your ApoE4 status and concern for your cognitive health. Ten minutes prior to surgery is not enough time for them to be prepared. I was the first patient to ever have both a spinal and epidural at my fairly large regional hospital. You can avoid general anesthesia. I found it very helpful to enlist the help and support of my surgeon. He fully supported my decision to avoid general anesthesia and guided the tenor of my overall treatment.
While I appreciate NF52's more hopeful studies, a broader look at the evidence demonstrates that E4s are especially vulnerable to some types of anesthesia. Print studies if you feel you need ammunition. I'm proud of you for being your own advocate and for putting your cognitive health first. You may be aware that you're about to undergo MAJOR surgery. I was pretty naive to that fact. Be prepared for a l-o-n-g recovery. Have lots of quiet projects, books, and movies to watch as you heal. -xo
Re: Newbie with surgery & anesthesia questions
Thank you all for your responses with links. I actually did find the anesthesia link in a search, but somehow missed the parts that answered some of my concerns. (Gotta write stuff down!). Is there a way to mark as favorites in discussions?
NF52, I was a lyricist only. Never could compose music and oddly, I can’t carry a tune. But I have written lyrics to an entire Kenny G album which was a lot of fun, and had co-written songs that are published with one in a movie. I might put writing lyrics to music on my bucket list during recovery. Something productive to occupy my l o n g a s s recovery. Thank you for your encouragement.
Julie G, I did read about your anesthesia discussion prior to getting a D&C a little over a month ago. The D&C surgery was done in a hospital who couldn’t tell me which anesthesiologist I would have until the day of surgery. But I did call the hospital ahead and they had an anesthesiologist on call answer enough questions that I felt empowered to request a spinal block. Like with your experience, the spinal is hardly ever done, so when I asked for it on the day of surgery, (nothing about the spinal was in the admission packet)we went on about the choices for probably a half hour while the surgeon and staff waited. I asked that, if the anesthesiologist found he could not do the spinal block, and had to do inhaled anesthesia, could he use desflurane as it had good results. He said, “We can use that class of inhalants, sivoflurane, desflurane, whichever..”...in my head, at this point, I knew he was NOT going to use desflurane which had good results...sivoflurane...not good in some cases. (Pardon me for spelling errors and lack of linking studies). But he did agree to do a spinal block and pumped me full of some anti-anxiety med similar to the Xanax I was already taking. Interesting, the nurses All had no experience with patients in recovery with spinal blocks and D&C surgery, so they had to look it up while preparing me. Although the D&C was only a 45 minute surgery, I felt good that at least one of the three anesthesia events I would have this year was not under general anesthesia. The lady in the adjoining room next to me was older who went under general anesthesia had difficulty with cognition and breathing...I was ecstatic I was clear headed. (Hospital charged me an additional $1500 for the choice, btw).
I will have an endoscopy in the next two weeks..that has to be general anesthesia I’m told. I don’t know if inhalant or intravenous TIVA are options, but will ask for desflurane if inhalant and not sure what to ask about TIVA...probably “yummy” proprofol will be used. My father in law just went through a colonoscopy and another one to stop hemmoraging. Both times, they used the proprofol. I was with him during the second surgery and anesthesia consult. Mentioned he was suffering significant cognitive issues since the first colonoscopy and you could feel the defenses rise when I mentioned dementia and they said proprofol was the best choice. He suffered a lot cognitively afterwards, but did seem to recover most obvious cognitive effects a week later.
The Urogyn group doing the surgery only schedules a ‘pre-op’ which doesn’t include a consult with the anesthesiologist but I may get one done ahead of the pelvic surgery since at this hospital, (unlike the hospital with the D&C), they may know who the anesthesiologist will be. If I recall from a convo with the Urogyn, she told me a spinal block w/epidural was not an option with this surgery. Probably because I’ll be awake and they just don’t do that. But, I’m encouraged that you, Julie G, were able to get that done and will push for that or the next best option.
I saw a thread here with some guy who was able to get the desflurane option, but couldn’t pull it up yesterday. I located today and saved the study that discusses inhalant vs TIVA, thank you for the link! I thought that I also found a recent study about the effects of some anesthesia in the brain of AD (or just elderly) patients many years later. This study discussed the inhalants and found desflurane to have no lasting effects, but not so with sivoflane?? Perhaps I have confused the studies and there isn’t really a long term study as I thought I recalled?
Thank you so much again for your help. Just being able to express my concerns and ask questions and get answers without a doctor wishing to hit me with an elephant-sized blow dart of Xanax...means so much!
NF52, I was a lyricist only. Never could compose music and oddly, I can’t carry a tune. But I have written lyrics to an entire Kenny G album which was a lot of fun, and had co-written songs that are published with one in a movie. I might put writing lyrics to music on my bucket list during recovery. Something productive to occupy my l o n g a s s recovery. Thank you for your encouragement.
Julie G, I did read about your anesthesia discussion prior to getting a D&C a little over a month ago. The D&C surgery was done in a hospital who couldn’t tell me which anesthesiologist I would have until the day of surgery. But I did call the hospital ahead and they had an anesthesiologist on call answer enough questions that I felt empowered to request a spinal block. Like with your experience, the spinal is hardly ever done, so when I asked for it on the day of surgery, (nothing about the spinal was in the admission packet)we went on about the choices for probably a half hour while the surgeon and staff waited. I asked that, if the anesthesiologist found he could not do the spinal block, and had to do inhaled anesthesia, could he use desflurane as it had good results. He said, “We can use that class of inhalants, sivoflurane, desflurane, whichever..”...in my head, at this point, I knew he was NOT going to use desflurane which had good results...sivoflurane...not good in some cases. (Pardon me for spelling errors and lack of linking studies). But he did agree to do a spinal block and pumped me full of some anti-anxiety med similar to the Xanax I was already taking. Interesting, the nurses All had no experience with patients in recovery with spinal blocks and D&C surgery, so they had to look it up while preparing me. Although the D&C was only a 45 minute surgery, I felt good that at least one of the three anesthesia events I would have this year was not under general anesthesia. The lady in the adjoining room next to me was older who went under general anesthesia had difficulty with cognition and breathing...I was ecstatic I was clear headed. (Hospital charged me an additional $1500 for the choice, btw).
I will have an endoscopy in the next two weeks..that has to be general anesthesia I’m told. I don’t know if inhalant or intravenous TIVA are options, but will ask for desflurane if inhalant and not sure what to ask about TIVA...probably “yummy” proprofol will be used. My father in law just went through a colonoscopy and another one to stop hemmoraging. Both times, they used the proprofol. I was with him during the second surgery and anesthesia consult. Mentioned he was suffering significant cognitive issues since the first colonoscopy and you could feel the defenses rise when I mentioned dementia and they said proprofol was the best choice. He suffered a lot cognitively afterwards, but did seem to recover most obvious cognitive effects a week later.
The Urogyn group doing the surgery only schedules a ‘pre-op’ which doesn’t include a consult with the anesthesiologist but I may get one done ahead of the pelvic surgery since at this hospital, (unlike the hospital with the D&C), they may know who the anesthesiologist will be. If I recall from a convo with the Urogyn, she told me a spinal block w/epidural was not an option with this surgery. Probably because I’ll be awake and they just don’t do that. But, I’m encouraged that you, Julie G, were able to get that done and will push for that or the next best option.
I saw a thread here with some guy who was able to get the desflurane option, but couldn’t pull it up yesterday. I located today and saved the study that discusses inhalant vs TIVA, thank you for the link! I thought that I also found a recent study about the effects of some anesthesia in the brain of AD (or just elderly) patients many years later. This study discussed the inhalants and found desflurane to have no lasting effects, but not so with sivoflane?? Perhaps I have confused the studies and there isn’t really a long term study as I thought I recalled?
Thank you so much again for your help. Just being able to express my concerns and ask questions and get answers without a doctor wishing to hit me with an elephant-sized blow dart of Xanax...means so much!
APOE 3/4
Re: Newbie with surgery & anesthesia questions
TWBD, in my country we do colonoscopies and gastroscopies with a little midazolam and a little fentanyl. Not anaesthesia. Ive had a colonoscopy myself, was completely non traumatic.
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Re: Newbie with surgery & anesthesia questions
Sorry I took so long to get back to you with the surgery & anesthesia results. I was lucky to get a really good anesthesiologist who called the the day before surgery, listened to my concerns and decided to do an IV of propofol as the main course. Unlike my surgeon, he would have done the epidural but since the surgeon said it was not an option, I decided against doing it. I didn’t feel any cognitive problems after a few hours. I did get a CNS Vitals Cognitive test the week before just to get an official baseline. Surgery went well.
APOE 3/4
Re: Newbie with surgery & anesthesia questions
Wonderful news!! Keep that anesthesiologist on speed dial for the future, although I’m hoping he won’t be needed again. You did a great job of asserting your right to be treated safely.
4/4 and still an optimist!
