GI wants a colonoscopy. -- NOW THEY WANT A CT SCAN ON HIS LUNGS

I would say it is certainly not your top priority at this point.

@SDianeL said:

My DH is 78, Vascular Dementia Stage 4-5. He doesn't understand directions, has lack of reasoning & logic, is angry & agitated. Screams at me to stop telling him what to do. (I only do so if he may hurt himself) He has visuospatial issues and prone to falls. He doesn't recognize words and doesn't recognize some foods. I've been putting off asking the doctor for medication to calm him because I didn't want him to be like a zombie just sitting in his chair but I think it's time.

Noy what you asked, but I would strongly urge you to schedule him to see a geriatric psychiatrist. Given the proffered order for a colonoscopy, I suspect your PCP doesn't really "get" dementia and medicating appropriately will be outside their wheelhouse.

Behavior is communication. Your DH's outbursts are likely driven by some form of anxiety and possibly depression that he no longer has the cognitive bandwidth to process. Medication could take the edge off and relieve him of whatever drives the behavior. A geripsych could prescribe medication(s) to dial back his edginess without reaching zombie state.

Last time he saw his PCP she gave me a referral for a colonoscopy. His last one was 3 years ago and they removed 2 polyps. We have a video appointment with the GI physician shortly. I'm dreading it because my DH hates video conferences. My problem is that I don't think I can get him through the prep drinking the gallon of stuff and then him sitting on the toilet all day and all night. And then the procedure at the hospital. He's also diabetic and fasting presents a problem with his meds & insulin. I'm going to mention all this to the GI doc but wanted to get input from this community. I'm mentally & physically exhausted. Has anyone gone through this with their LO?

I would not. I would consult his neurologist around this if you feel you need to consult someone. As with any test, I would ask myself what I would do with the information obtained. If they found cancer, would you treat aggressively in the context of him already progressing with a terminal disease?

HB

My mom is on anxiety and depression medication. She is not a zombie. Her doctor started at tje lowest dose. Even when she was on an antipsychotic med, again, it was started at just enough to take the edge off.

I myself am now on the 3 year plan for a colonoscopy as my two polyps were precancerous. So I understand the concept of go in, find them and prevent the cancer - continuing past age 75. Your spouse definitely couldn’t take the cancer treatment if polyps were left to develop into cancer.

However, I’m not sure he can handle the prep- even if now they give pills instead of nasty tasting drinks. Will he fast or will you find him eating during the day? If not then it’s a wasted effort as they can’t see anything. Will he station himself in the bathroom for the needed duration? Diabetics ate slower to digest etc. Not all of my spouse’s colon was able to be seen at his last colonoscopy.

I suggest you call into the GI’s office and explain the situation to the nurse. That way the doctor will be informed prior to the video appointment and can pay close attention to your spouse’s condition. Ask the doctor how soon the polyps could turn into cancer. Also ask the doctor about the anesthesia as it is usually very light for a colonoscopy. You are actually awake, but not really aware.

I think this will be the last time he will be able to have one done because of dementia progression expectations. So I’m not sure having one now is doing more than moving possible cancer out into the late stage of dementia.

My parent’s’ PCP hasn’t even mentioned one in the 3.5 years I’ve been attending the appointments. I have no idea what was found in the last ones they had or when they had them. I am not going to ask the doctor about one. My parents are 4 and 6 years older than your spouse and are at stage 4.

Hi--

Agree that medical management of his behaviors would be helpful. It doesn't sound like your husband has the capacity to participate in his healthcare decisions, so he doesn't necessarily need to be included in the video conference. You should be very blunt with the GI doctor about his behaviors and the difficulties you have in managing them. They can always defer the procedure until his behaviors are better controlled, or decide not to do one. There's always the concern that he might need general anesthesia for the procedure if he continues to be unable to cooperate fully, in which case there may be issues with him recovering to his baseline afterwards. Again, should be discussed if you all decide to go ahead. If they were to insist on the colonoscopy now, then it might be worth asking that he be pre-admitted overnight for his prep because of his underlying medical conditions.

I too question the PCP. What does your husband's neurologist say?

I also would say a firm "NO". When my mom was in her 90s, her PCP ordered a colonoscopy. Fortunately she was still able to express herself, and, with my urging, we told the doctor "no".

Most doctors today are employed by hospitals , run by large, for profit corporations. They are following a template that is dictated by these conglomorates, and it's a "one size fits all" set of guidelines. Thankfully, you have the power to make the decision for your husband, and I second a previous response: what kind of treatment could he possibly be able to tolerate ?

All good thoughts for you,

Maureen

I agree with all those saying "NO". So much so, that I searched up this thread from before. See link below.

It was the colonoscopy, auto-pilot type of referral in the mid-stages of Alz that let me know our longtime PCP had no clue, and no real concern re appropriateness for a PWD. He wasn't reading the neuro team's notes, and not even using common sense in my view. I had to advise him we were going to pursue a palliative care approach for my DH and would not be doing every random thing that can be billed for, anymore. That dementia was now his primary condition, and it would dictate what we did about any other health matters.

If you've been through a colonoscopy yourself, the prep is horrible -- I did not know what to expect and felt like I was dying. Really thought they gave me too much stuff (turns out they did). I was, and your DH would be, truly miserable with no idea what's going on. And for my DH now, the anesthesia impact alone is a deal-breaker for me. Why do something that would almost surely advance his cognitive decline, while causing discomfort (maybe even pain if further invasive procedures follow on from anything "found" during a colonoscopy). And the procedure itself is not risk-free. All caps NO, full stop. It was the 2nd reminder comment from his now former-PCP semi-admonishing me that we were "late" with DH's colonoscopy and needed to schedule it (i.e., just do it anyway) that sent me looking for a geriatric specialist to take over as PCP from then on. It is actually cruel, irresponsible and probably unethical in my view, for a Dr. to put a geriatric PWD through a procedure like this. Why? Oh yeah, because its billable. And your DH is not in position to say NO. You have to tell this Dr. what's best.

Also, Seroquel (Quetiapine) for us has been magical. I've said many times, I could not keep him at home or safe, without it. He has never been a zombie despite fairly high doses for years now. 100 mg, 3x daily. FYI, it takes time to find the right dosage and schedule, so definitely try the meds to help comfort and address his behaviors (communicating the only way he can) and keep asking questions here.

Colonoscopy(2) — ALZConnected

The Colorguard route 'might' be a way to proceed. Of course then a decision would have to be made if it showed the need for further testing. Of course, at that point you could refuse the further testing because that would be a colonoscopy.

If you are led to proceed with the colonoscopy, make certain you stay by his side. You just keep repeating it to everyone. Ask to speak with the anesthesiologist prior to the procedure. Make your concerns VERY clear, don't allow your concern to be over looked. Ask about using Versed, and exactly how long your DH will be sedated. One other thing, does he use a CPAP? If yes, take it with you. Demand, and I do mean demand, it be put on him immediately after the procedure. That will start getting oxygen immediately flowing.

eagle

Best advise we got for my Dad was from an ER doctor whose father had dementia.

He said he could do all kinds of testing, but unless we were prepared to put Dad through procedures required/needed based on the results...there was no need for the tests.

While it is hard to "deny" our LO of what for others might be normal testing/procedures, we have to consider that these things can be fatal for a person with advanced dementia...either from the anesthesia or after care requirements which they are unable to follow.

No way would I put my DH through this. If he had cancer, nomway would I seek treatment. (I know what that entails. My DH had stage 4 throat cancer at 62. Brutal. BYW, I am a fully healthy 76. I just had what I decided would be my last colonoscopy.

It's refreshing the physician listened to you and didn't push the issue. Good for you.

eagle