Does my mom really need surgery for her hernia if she's not in any pain or discomfort???

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Does my mom really need surgery for her hernia if she's not in any pain or discomfort???

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I took mom for a routine physical last week and the Dr said she has umbilical hernia - her belly button is big. I don't know how long mom has had this hernia because she has lived with me for two years. Before that, she was in our home country, India, in a senior community and never went for routine checkups.

I got her here in 2019 after "dragging" mom to a very quick checkup in India (blood work, BP only), skipped all Drs last year.

Mom is not in any pain or discomfort and says she doesn't want any surgery and to leave her alone. The Dr says we have time to think this over and as long as the hernia is not infected or collapses, mom should be ok.

Mom has moderate dementia and I worry about the anesthesia affecting her badly even if it's a small surgery. I also have to now switch insurance plans to get a lower deductible.

Thank you for sharing your thoughts on this.

Alzheimer's & Dementia Care Decisions Senior Health

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Thank you for all so much. Definitely a lot to think about :-))

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My mother's cardiologist gave me the best advice. He told me to always expect the worst-case scenario and only do what needs to be done when it's life or death. I never got surgery for my mother's hernia. They wanted to do surgery when my mother swallowed 2 hearing aids. I didn't let them and they passed on their own. I did let them do a hip replacement when she broke her hip. I felt that was necessary. She was 91 with late-stage Alzheimer's and did fine. Take it a day at a time and do what has to be done. If it's not life or death, watch it.

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I would not do it on your mom at this time. There are cognitive loss risks to general anesthesia in elderly, which I believe are greater with any dementia. There are also risks with leaving a hernia unrepaired. Her doctor is willing to wait, so that is what you should do. That said, I had hernia surgery myself recently...felt very uncomfortable with it and scheduled the earliest possible surgery. I know several who have had this umbilical surgery in their 80s.

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Imho, it is IMPERATIVE that you consult with your mother's gastroenterologist for the answer.

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Your mom should have the surgery. The problem with umbilical hernias is that the small intestine can become entrapped. Once it does, it becomes painful and that section of the intestine will "die." This is a life-threatening scenario, which would require massive surgery to remove the section of intestine and resect what remains. One of my parents required an emergency surgery due to entrapped intestine. It took three weeks and two drains before he could eat any food again; the bowel has to "wake up" after the surgery and until it does and food can move, no food by mouth. He lost about 30 pounds and due to being bed ridden, lost strength and conditioning. He was so behind in nutrition, that they put in a G-tube to supplement his nutrition. His recovery from emergency surgery took four months. There is no alternative to this surgery except a painful death. Your mother's wishes are important, but if I were her daughter, I would encourage her to have it done. This is a perfect example of "an ounce of prevention is worth a pound of cure."

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To answer simply no she doesn't. My father had a hernia for years he could press on it and pop it in And out it didn't oroturb and it painful. No do as she wants. No surgery.

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Just chiming in to agree with the many responders who have advised against the surgery. My mom is 91 and we are not doing anything about her hernia. I agree with your concerns about anesthesia.

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My mom is 95 yrs old and has 2 hernias in the abdominal area. She’s had them for years. She doesn’t want to do anything about them and they don’t seem to bother her. My mom has many co-morbitities and the hernias are the least of them. I forgot all about them until reading this!

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Anesthesia does often make the dementia worse. Avoid any unnecessary surgeries. Most doctors agree it safe to monitor the hernia until it becomes symptomatic. There are also natural remedies to help. This is just one website with some ideas. You can check it out or go to any others you like.
https://www.naeturalhealthinformation.com/hnh-herbal-comfrey-poultice.html

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indeed: i heard the same advice from doctors.

leave the hernia alone.
no pain? leave it alone.

many people can live years and years with asymptomatic hernia.

operating can kill an older person.
absolutely not worth the risk.

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You have good suggestions from others about the hernia.
Look online at bath chairs to see if one would work for your mom. My age-90 mother-in-law angrily refused to take a shower or bath. We opted for bath since she never took showers growing up, and purchased a bath chair. She sat covered with a towel, then slide over the tub, then push the remote control to lower the chair into the water and remove the towel as she got in the water. The chairs that go down into the water are more expensive but may work well for you. Remember that older women get cold easily, and don't want to remove clothing to change or take a bath! Be sure the bathroom is very warm (too warm for you) so Mom won't get too cold.

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I would ask two questions;
1. What is your mom's quality of life at this point? If she has a low quality of life and getting this operation is not going to help then you need to decide if it's worth getting this surgery.
2. What does your mom want? You said she is doesn't want the surgery. If she can weigh the pros and cons and understand the consequences of not getting the surgery, she decides to make it.

Try to focus your decision on what she want's; this is hard for families to do because they often feel the senior is using poor judgment. We all make poor decisions from time to time, but that does not give someone the right to make decisions for us.

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A hernia is a piece of intestine poking through the muscle wall of the intestine. If it becomes seriously "pinched," that part of her intestine will die and she will need a much more invasive surgery. That surgery will include cutting out the dead part, trying to connect the living parts of her intestine together, no eating until the wounds heal... and could also lead to having a permanent ostomy (bag on her stomach for products of digestion to flow into). Hernia surgery is much simpler in comparison. In this surgery, the skin and muscle wall near the hernia are incised. The intestine is "pushed" back into place. Internal sutures are placed to reinforce the muscle wall and sutures or staples are used to close the skin. The amount of pain is lesser as well as the recovery time. Hernia repair requires much less anesthesia and she will most likely be able to resume eating the day of surgery or the day after. If it were me or my family, I'd opt for the hernia surgery. The surgery can wait as long as mom has no pain (evidence of "pinching off") and she can eat and defecate without problems.

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Agreed. Have already dealt extensively with step-father with umbilical hernia. It happens to all ages by the way. This is the most susceptible area since we were connected via the umbilical cord to our mother during pregnancy and it can open up. If you decide not to have surgery due to the dementia (I agree, anesthesia is bad for ALL), I would ask the GASTROENTEROLOGIST if she could start Metamucil once a day between meals without her vitamins or medicines. This has worked wonders for my Step-Dad and is actually beneficial for all. He takes it first thing in the morning and then has coffee. Eats breakfast at least an hour later and takes his medicines/supplements at the end of his breakfast. For my Aunt who has severe dementia that I care for, it works best for her to provide the Metamucil in the afternoon between lunch and dinner (not for hernia but for regularity). She sleeps about 12 hours and I want her to drink and eat when she first gets up so this time works best for her. It can be filling so it is like a snack and this way not interfere with her medicines given at breakfast and dinner. Good Luck.

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I don't even know why the doctor would suggest it. This is the main reason I never go for routine checkups. They always find something to test or treat. Unless I have symptoms I cannot cope with on my own or doesn't go away, I do not go to the doctor.

Once again I recommend the book by Dr. Nortin Hadler: Rethinking Aging: Growing Old and Living Well in an Overtreated Society.

There are way too many tests and treatments and people do not consider the risks vs the (maybe) benefits.

BTW, I think I've had an umbilical hernia for almost 40 years, and I'm still here. No pain, no problems.

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These days it's all about the $$$. MD probably works for a system with a quota of bringing in $$$ or procedures. If that concerned you can get a 2nd or 3rd opinion.

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If it were my mom, I would not do the surgery. When someone is older and has dementia, you have to weigh the risks and the outcome. If the hernia changes and begins to pinch and cut off circulation of her intestines, you won't have a choice in the matter, but if she is fine now, I would let it be. Try to keep her weight within normal range as excess weight only exacerbates a hernia.

Pay close attention to how the hernia looks and how she feels because any indication of it being strangulated or "pinched", you will have to act on it quickly with surgery.

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Depends on her age. Anesthesia carries enormous risk, much more than the actual surgery. With underlying dementia, so increases the risks enormously. With COVID the risks of postoperative care is much higher since the facility will restrict visitors. You have to watch your loved one around the clock like a hawk while in the hospital. YOU have to do it. The hospital won't. You also have to get them up and moving as soon as possible -- it won't take long to become bedridden PERMANENTLY. So you also risk them becoming permanently bedridden.

Even in the United States MOST doctors do not care about you or your loved one. They just like pushing drugs and get money, and if they have the opportunity to cut they will do that. They live champagne and caviar lifestyles, driving around in their Rolls Royce living it up as multimillionaires -- all they care about is getting money. You have to live with the consequences. They are greedy people in cahoots with pharmaceutical companies paying them money hand-over-fist!

Do not do surgery unless it is ABSOLUTELY necessary.

https://www.asahq.org/madeforthismoment/preparing-for-surgery/risks/age/

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Based on my recent experience as a pre-senior NO ONE should be in a hospital bed /setting alone. Take pen and paper and track every single person who comes into the room and what they do. SAY NO to what is safe to say no to. I.E. repeated lab work, repeated chest xrays. I think it is a way they are padding the bills, and in the end the insurance doesn't cover it all. I am sitting here with a 5K bill from the NON PROFIT Cleveland CLinic with what was not covered. If only the wealthy benefactors would consider how people truly suffer with debt instead of building more shiny buildings...

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Don't do the surgery. My mom had the exact same situation. She had her hernia for years. New doc said have surgery. I listened to doc. Mom did decline mentally and physically. Worse decision I ever made.

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My mother in law could not talk for 3 days after surgery at 97. In my MIL’s case the surgery was needed, broken hip. She did walk after the surgery without a walker. But the after affects of the anesthesia was scary those first few days.

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Please don’t allow her to have the surgery. My dad had very mild forgetfulness was independent living. He had a hernia operation. Although the operation went well, he came out of it w hallucinations strange behaviors. We had to put him in assisted living. His dementia was advanced by several years. Quite quickly he had to go into a long term care home because of wandering looking for a car he no longer had. He was around 80 when he had the surgery.

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Surgery can take a lot out of people when they are older. She may be right to want to put it off unless it is necessary. Are there any natural cures she can try in the meantime? Any ways to strengthen the muscles around that area?

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No surgery is not necessary, unless it becomes strangulated, then there will be pain. My mother has had a large hernia ( probably the size of a cantaloupe )now for over 4 years Dr says no pain no surgery. She has LBD. We do the least amount of tests and medical dr visits for her because what is it going to do, nothing will help her nothing will change she is 92 and is basically bed bound. Visiting nurse comes to ck her periodically and a home health aide visits weekly. Other than that I do everything for her everything. The Dr. said as long as it’s soft and you can move it around with no pain it is fine.

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I was interested that the doctor said the hernia must be operated on. I wonder how long it has been present and how big it is. Does she have an obvious “outie” belly button? You can feel the opening yourself by pressing gently with your fingertip over the belly button while she is resting on her back with her abdomen soft.

There are a couple of concerns with these types of hernias. One, obviously, is it getting bigger and causing discomfort. The bigger it is, the bigger the job of repairing. The second more concerning issue is the risk of it getting trapped and strangulated. Sometimes only a little abdominal fat gets trapped and sometimes the intestines themselves.

If the opening is quite small it is easier to repair but also higher risk of fat or intestines to get strangulated. I am a family practitioner not a surgeon, but I would consider a small one to be about the size of a fingertip.

Get familiar with the feel of the hernia and with reducing it. Does it slip back inside easily when she lies down? Or does it need encouragement? If it needs encouragement the the risk of strangulation is higher. If it does get stuck out it will be painful and tender. You will need to be able to reduce it quickly if possible. She may only complain of “belly ache” as the nerve fibres are different so the sensation is not the same as for skin. Red and swollen and/or very tender MUST be seen by a surgeon as it may have strangulated. Even strangulated fat would possibly need to be removed to avoid more serious infection. Just a bit tender and uncomfortable for a short period get her to lie down and relax and see if you can gently wiggle it back in. If you decide against surgery and it does get trapped then you might want to reconsider.

I would also have a discussion with a surgeon about the possibility of a repair without a general anaesthetic. Again I am not a surgeon or anaesthetist but what about regional anaesthetic and sedation. The surgery itself would be quite quick usually (sometimes only 15 min or so) unless it is dealing with a strangulation or obstruction when surgery may be much more serious. Just some thoughts that I hope you find helpful.

As far as her bathing goes, I wonder what her circumstances were when she was younger. Is she more used to having a wash than having a shower? I wonder if she would be more comfortable having a shower chair and a hand held sprayer or even a bucket and jug. And of course a warm bathroom!

I’m inclined to agree that you may want to consider getting her used to something like depends, at least sometimes. If she hasn’t worn underpants for years you might have a battle! But at least for urine they are very good and you can remove them by tearing them at the sides. If her incontinence gets worse and you do end up needing to get her in a home or hiring outside help they might not be willing to deal with incontinence without them.

Good luck!

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Ubless the Hernia grows bigger or causes her to be uncomfortable/
pain then you should do as mom says and leave her alone. No Surgery.

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If that hernia does go "pear-shaped" on your mother she might be very sorry indeed that she didn't get it seen to while it was comparatively routine. Hadn't you better ask her doctor to explain the risks in more detail? How likely is it to develop into something more serious, is what you need to know; along with whether "watchful waiting" might be a reasonable compromise.

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Although it may seem like it won't help, the first thing I can suggest is try to lose the anger with your brother. It won't impact him, only you. It won't change anything. The best you can do is just forget you have a brother. The anger will eat away at you. You can't afford to use your vital resources feeding that hate and anger, esp since it will not change the situation. I've dealt with this and TWO brothers, equally jerks, but for different reasons, and for the most part, absent.

BTW, if you haven't already checked with Medicaid or an EC attorney, perhaps this can help:

https://www.agingcare.com/articles/medicaid-and-long-term-care-133719.htm

Medicaid can be available to "qualified non-citizens" - depends on what your mother's status is. I should think if she were only here on a visa, it would have to be renewed over and over. She must have some other status to be able to live here.

Another lookup (healthcare.gov) gave these and other names/relationships:

The term “qualified non-citizen” includes:
Lawful Permanent Residents (LPR/Green Card Holder)
Asylees
Refugees
others...

There is still the 5 year "look-back" requirement. There are additional state regulations (primary are residency and income/assets.) The NHs also have requirements. But, if you haven't explored any of this, you should. No guarantees, but a few phone calls should determine if she might qualify. If the Medicaid person who takes your call doesn't sound especially certain, ask for a supervisor.

IF she qualifies for Medicaid, but not a NH, Medicaid often pays outside help or family members for some in-home care - it isn't full time, but every little bit helps! Although she has rejected the aides, perhaps you can find someone, maybe even someone of East Indian descent, that she might eventually mesh with. While companionship is often hoped for, the primary goal of having an aide is for care purposes. A good aide who has worked with dementia patients will have a skill set that can help them break through. I wouldn't give up hope yet...

(p.s. I also wouldn't listen too much to the relative docs back home - they mean well, but if they haven't examined her or have expertise in those fields (hernias AND dementia), they shouldn't be armchair diagnosing and suggesting surgery. An ultrasound, a second or even third opinion (not a referral - find someone unrelated, but wait for the imaging) - as others noted, if it isn't causing her pain, perhaps it can wait longer or just leave it alone. If it's really small, but all agree she needs the repair, ask the surgeon if they can use a sedative and local anesthesia or an epidural - I had foot surgery without anesthesia (they wrap the lower leg and use something in the foot only.) The sedative knocked me out!)

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Many thanks for your valuable input.

I will try to forget my brother but it makes me so sad to see my husband stepping up and doing everything my brother should be doing. However, my very patient husband is also now getting annoyed by my brother. I guess I should show him all the" siblings not helping" posts here. I will look up the Medicaid info and I am taking mom for the ultrasound.

Have a good day.

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I've scanned your earlier posts, and have some question for you.

You wrote back in September that you had taken leave from your PT job. Is this still the case? What happened to your mother while you are working?

You wrote that you would be okay putting her in a MC facility when the time comes. Yet you also stated that you don't know how that would be paid for. Your mother isn't eligible for Medicaid, correct, since she came here from another country?

"I dread taking care of her after surgery even if it's a minor procedure. My hate will be aggravated by the fact that my brother is away from all this in another country and does nothing to help me."

Is your brother one of the family members in India who want the surgery? What do you expect your brother to do to help you?

"She has always been lazy about hygiene and my bad luck that now I have to deal with it. It will be a battle to get her to wear Depends. I will not change her Depends- no way."

So what is the plan as your mother becomes incontinent, if you will never do Depends? What is the plan for her long-term care? Right now it looks like YOU are the plan.

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I am back at my job after my 4 months unpaid leave was up. My husband and son are at home working/studying thru Zoom..they keep an eye on her.

Brother is in another country (not India) . He has left all decisions to me because he doesn't want to care for her. I expect him to contribute monetarily to her insurances costs. He will not do this because it was my decision to bring her to America - he preferred mom to stay back in India with an aide and spend her own money. But he would not help in supervising the aide from far away and there was noone else to check on the aide and so crazy things happened .

Yes, of course I AM THE PLAN now

There is no long-term care plan yet. For the time being, I will throw away her soiled clothes and washing them is easier than struggling to put Depends on her. We don't have the money to put her in a AL/NH here with private pay. I could take her back to India, use up her money, hire an aide and get migraines again as I stay up at night due to the time difference.

Im trying my best to detach from mom and do what's right for my family..it's much harder than I thought.

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No. The doctors told me I did not need surgery unless it was bothering me. Unfortunately mine was bothering me and I had the surgery.

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Have you read "Being Mortal" by Atul Gawande? He addresses end of life decisions, and describes various cases. It may or may not help you make a decision about your mom, but it will certainly validate your concerns and difficulties making decisions.

Dr Gawande shared his father's (also a medical doctor) experience. He refused to stay in the hospital and came home to die. His wife's goal was to keep him awake as much as possible. His own goal, which he privately shared with his son, was to avoid pain. Those goals were conflicting.

In your case, do you feel that you know your mother well enough to know what she would decide?

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Thank you. Yes, I did read that book.

If it was major surgery, I'd not even think about doing it but everyone says the hernia is one-day surgery.

Mom will not want the surgery at all. I spoke to Drs in the family based in India and they all recommend the surgery "before the hernia gets infected, strangulates, why take a chance?"

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Can you get another opinion? My 94 yo mother with dementia has had double hernia below belly button...for several years...yes it’s gotten bigger...but I took her to top hernia specialist at age 88 when she still walked...& dr told her if it doesn’t bother you, don’t bother it...& if it does start to bother you, make another appointment to fix it. Right now...believe me, it’s the least of my mother’s problems with full blown dementia....I hope that my advice helped! Hugs 🤗

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I will take mom for at least the ultrasound and then decide, I guess. I've been speaking to Drs in the family who are in India and they recommend the surgery.

Thank you

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Alva's answer is pretty all inclusive as far as repercussions. I had a double inguinal hernia that was quite distended and concerned me. Although it wasn't an emergency, I decided to have them repaired under general anesthesia by robotic (minimally invasive) surgery because I didn't want it to become an emergency. But I didn't have dementia. Dementia adds another level of risk. Certainly some people with dementia need surgery. Anesthesia can have a disorienting and negative effect on the patient. If the hernia is getting worse, that's a concern. Of course, all surgeries have their possible complications so you must understand what those are by speaking to her dr. In addition, even after surgery hernias can return. So you need to monitor your mom's hernia and get all the facts about the surgery before making a decision. Good luck.

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You are absolutely correct in being concerned about anesthesia in the elderly. While some doctors still deny it exists it does indeed exist, and is a huge concern.
I think that you can only make decisions about this with the MD with a full discussion of the risks of leaving this hernia unaddressed. The bad outcome you do not want is that a section of bowel can move into this pouch and become trapped there, then that portion of the bowel can die, leaving what amounts to infection and disruption in the entire gastrointestinal system. This complication can lead to death. This is why doctors want to address the issue before something like this can happen. For information on this condition look up "Umbilical Hernia with incarceration or strangulation of bowel". This will give you the dangers that "could" be on the horizon.
Wishing you the best. Consult with the doctor and explain your concerns about anesthesia. Some surgeries are very quick and more surface and superficial, and minimal amounts of anesthesia can be given.
Hoping for the best in your decision here.

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Thanks, Alva - off I got to make more phone calls now:-).

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I would leave well enough alone, as you are aware, the effects of anesthesia can be devastating for an older person, especially one with any mental decline already. If things take a turn for the worse and the doctors say she has no choice but to have the surgery, you can address the situation then. But until then, let it be.

Also in one of your responses below, you state that mom doesn't always make it to the bathroom on time and that you have to clean up pee and poop, but yet you don't feel she's ready for diapers yet. Really??? I'm not sure I'm understanding your thought process on that one. Why would you not want to make your life and caregiving duties as easy as possible? If she's having accidents, then it's time to buy her Depends. They make pretty ones for ladies, and I would recommend never calling them diapers in front of her, as that can be humiliating for a person. Just call them her new underwear, or panties. I wish you the best in caring for your mom.

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Mom has not worn underwear in 20 years - even before the dementia. She has always been lazy about hygiene and my bad luck that now I have to deal with it. It will be a battle to get her to wear Depends. I will not change her Depends- no way. It's much easier to clean the poop than try to get the Depends off her and I'd rather throw out her soiled clothes.

Thank you for helping me clarifying my own thoughts about D vs cleanup!

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Does my mom really need surgery for her hernia if she's not in any pain or discomfort???

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