Colonoscopy?

Barbie300

My DH is in the early to middle stage of Alzheimer’s. He has been getting colonoscopies every 5 yrs because of ongoing problems with polyps. Now he is past the 5 yr mark and his DR does not want him to get anymore. I’m not sure I agree bc he is in excellent physical health and could live for many years. If he develops a colon blockage from polyps I’m not sure what should be done about him having surgery at that point. It seems he would almost have to go through the surgery. His father died of that exact condition, during surgery to remove a very large intestinal polyp.

Lgb35

hi Barbie300

How old is your DH? Would he understand the prep and procedure at this point or would it be confusing for him?

annie51

My DH had some small polyps removed on his last colonoscopy so when the 5 year point came I had to make a decision. At that point he was 75 years old, almost 76, and probably Stage 5 Alz. Three things made me decide against doing it: 1) based on how he was at the time, I knew that the prep and procedure would be a problem - it would be confusing and cause him stress as he wouldn’t remember what it was for and I don’t know if I could get him to comply. 2) I read that colonoscopies after age 75 are higher risk 3) if he had questionable polyps, I asked myself what I would do with that information. These are very tough decisions that are most likely easier later in the progression.

Also what reason did the DR give for not wanting to do it?

Quilting brings calm

Does the doctor think a blockage from polyps is likely? If not then I wouldn’t worry about that possibility.

Normally the polyps are removed because polyps are where colon cancer starts. I had a normal colonoscopy. Then 10 years later I had three polyps. Next colonoscopy 3 years later. 1 polyp so now I am on a 5 year schedule. The timeframes are to ensure they catch polyps in time to remove them before cancer develops. They also knew how big each polyp was.
My spouse is on a 5 year timeframe because his mother had colon cancer (removed by surgery, no other treatment. His older brother just got told he didn’t need any more colonoscopies at age 75.

Joe C.

When DW was about stages 3 she had a lumpectomy and the recovery process was challenging. They 1st day after surgery she ripped off the bandage which was suppose to remain in place for several days and she did not want to were the support bra the doctor prescribed. Although she understood why she was getting the surgery initially, once it was done she did not understand the reason the reason for recovery care. A couple of years later when she was about stage 5, I made the decision to stop colonoscopies and monograms because I knew she would not understand why I was putting her through prep/procedure and if they found cancer I felt she could not tolerate the chemo or radiation. Including the lumpectomy DW was hospitalized 3 times during her progression, following each hospitalization she experienced noticeable decline in her cognitive and physical capability. It is a difficult decision but I reach the point where I did not want to do anything that would accelerate her decline and from first hand experience I knew another hospitalization would do exactly that.

harshedbuzz

@Barbie300

I am sorry you are facing this decision and feel uncomfortable with it.

It's seems as if you have landed on a physician with some knowledge of dementia and its progression. It might not seem so in the moment, but you are fortunate for a specialist who sees the bigger picture. So many of us have had to deal with clueless physicians who just want to follow the script for healthy individuals with normal life expectancies.

Based on your previous posts, it would seem your DH is solidly in the moderate stages of dementia given the 7 years since MCI diagnosis and his current level of impairments and symptoms. However healthy he was previously, dementia will impact his life expectancy.

https://www.verywellhealth.com/life-expectancy-in-alzheimers-disease-and-dementia-2223967#toc-life-expectancy-for-different-types-of-dementia

Based on a every 5-year colonoscopy schedule, I would assume his doctor is not overly concerned about a polyp blocking his intestines. DH was on an every 6-month schedule for a time after removal of a complex polyp, then yearly before going to every 5-years.

TMI for the rest of you: My friend who has a familial issue with polyps had colonoscopies every 6 months until it was decided to remove her part of her colon. Her surgery, in addition to requiring general anesthesia (which can cause progression in dementia) and a 6-day hospital stay (which could cause delirium and progression in dementia) has resulted in some issues managing her bowels. She is fortunate to have avoided a stoma but she does have some urgency at times and the pH of her stools has changed to a degree that were she in Depends, her skin would be quickly damaged.

If he did develop a polyp that was causing an issue, it could be addressed then accepting the risks of surgery/hospitalization at that time giving him longer in his current stage of dementia or decide to bring in hospice for comfort care only.

I am sorry you have to deal with this.
HB

Barbie300

https://alzconnected.org/discussion/comment/252834#Comment_252834

His internal medicine DR doesn’t seem to think anyone over 75 should have a colonoscopy. His gastroenterologist sent him a reminder that it was time for his next colonoscopy, but I don’t think he’s aware of the Alzheimer’s diagnosis. Thank you all for your comments and support.

Barbie300

Thanks for all the comments and support!

JJ401

“His internal medicine DR doesn’t seem to think anyone over 75 should have a colonoscopy. His gastroenterologist sent him a reminder that it was time for his next colonoscopy, but I don’t think he’s aware of the Alzheimer’s diagnosis.”

I’m the one on the frequent schedule (mostly 3, sometimes 5). DH has never had a polyp and has always been on the ten year schedule. I dreaded the prep of him having another colonoscopy. After my last one, after going over my results with my gastro guy, I asked him his opinion of DH getting another one. He unequivocally said that at DH’s age, with his history, of no polyps, and dementia stage, he would not perform a colonoscopy. So when DH’s primary mentioned it was time for his colonoscopy I nixed the idea.

With your DH’s history, I think I’d call the gastroenterologist office and inquire if they are aware of the dementia diagnosis. And if they were not, ask if the knowledge of a dementia diagnosis makes a difference in their recommendation.

Lilydaisy

I usually follow the doctor's advice. My DW is stage at 74 and had a colonoscopy last week (her last one.) It went fine. There was a small polyp that was removed and is in biopsy. No serious concerns but now that it is over I'm glad she did it. But if her doctor had suggested skipping it she likely would have. Either decision is probably fine.

SDianeL

I stopped colonoscopies in Stage 4. My husband had a history of polyps. Reasons why I stopped them: He would not have been able to do the prep. The anesthesia would have been bad for him and could have caused progression of the Alzheimer’s. What would I have done if they found cancer? He would not have been able to go through treatment.

trottingalong

My husband is 81. Has been on 3 year cycle of colonoscopies for years because of small polyps. It’s been 3 years now and I won’t put him through it again. He has COPD along with the Alz. Any time he is put under, he is more confused for 2-3 days. I see no point at this stage of putting him through it again.

elainechem

After my hubby was diagnosed with EOAD, I decided that he should never get another colonoscopy. But then, 5 years later, he managed to get a case of ischemic colitis. He was hospitalized and they gave him one there to confirm the diagnosis. That was okay because he was sedated the whole time. The problem occurred two months later when they wanted him to have another colonoscopy to see how he was doing. That was a nightmare! We were at home, of course. He didn't understand why he needed the prep. He was miserable and fought drinking anymore toward the end. Fortunately, he had had enough for the procedure. But I vowed that I would never subject him to that no matter what.