Should my mother have a pessary inserted, undergo a pelvic ultrasound and get a biopsy of her cervix?

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Should my mother have a pessary inserted, undergo a pelvic ultrasound and get a biopsy of her cervix?

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My mother is 97, has dementia, and is extremely hard of hearing. When a visiting nurse discovered that she has a prolapsed uterus, he urged us to take her to the ER, which we did. Being there for several hours was very traumatizing for her. Two days later, she was examined by a gynecologist who recommended the above procedures. I'm not sure what to put her through. After the gynecologist's exam, she said she had gone through major surgery and was grateful for being fixed. I can see the necessity of the pessary to keep her uterus in place, but why put her through the ultrasound and biopsy? If she had cancer, we would not put her through any aggressive treatments.

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At her age of 97 I'm not sure why you would even consider any of it. Is she in any pain or discomfort? If not and if it were me, I would leave well enough alone, and let her live that rest of her life as comfortable and non traumatizing as possible. She deserves that much. Best wishes.

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I thought the same thing when the original poster said the nurse "discovered" the prolapse. To me, that means her mother was not complaining of any discomfort or pain that led the nurse to even look for that. I honestly don't know much about a uterine prolapse, but it being "discovered" made me wonder why she needed treatment if she wasn't uncomfortable.

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I don't know how invasive that is but unless it would alleviate pain, I wouldn't do it. My dad is 93 and I know it's a really hard decision but I've decided not to do anything that involves procedures on his heart again. (and I'm not even talking surgery, just test-type procedures). Its a hard choice though. The surgery he had two years ago was considered to be fairly non invasive ( 1-2 nights in hospital and quick recovery as it was done robotically somehow)... anyway, he has never really recovered from the surgery and it made his dementia so much worse.

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I've heard far too many stories of women in the nursing home with an untreated prolapse, I would definitely opt for the pessary but not any of the rest of it. And just so you know, there are pessaries that can be left in place for an extended period of time (several months), there shouldn't be any need to remove and clean it daily.

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Prolapse is very uncomfortable, and could get her into all sorts of hygiene/infection issues too. Never mind the biopsy, I'd be asking for recommendations on preventing recurrence.

PS The gynaecologist would be very wrong not to *offer* the full range of options. Explain them to your mother as clearly as possible and as much as she's able to understand, and give her a choice in what happens next.

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Need Alva here. If it was me, I may have the pessary inserted. What I read says it won't be uncomfortable. Did the GYN not take a pap smear when he/she checked her out? If so, did cancer cells show up? If not, why do a biopsy. And even so, I would not put her thru it. Ultrasound, is this so they know where to place the pessary?

I stopped a few of Moms doctors and procedures. She got to the point she didn't want being touched. Like you said, if something was found we wouldn't have treated it.

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My mother was told a few years ago (with absolutely no evidence) that she had ovarian cancer. She hadn't had a gynecological exam in decades, so the ultrasound was excruciatingly painful for her and the only good thing that came from it was the proof that her doctor was a bonehead. I wouldn't recommend it unless it was absolutely necessary to save her life, and even then, at 97, her care should be focused toward her comfort and little else. (In my opinion, of course.)

It's always OK to say no to doctors. It doesn't occur to them to let you know that's an option. Ask if there are other options, but unnecessary procedures should be pretty low on the list.

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Presumably, the ER found some evidence that this might not be a simple uterine prolapse due to relaxed pelvic organs. Perhaps they found evidence of a growth or mass. The gynecologist recommended an ultrasound of the pelvis to verify if there is a mass (tumor) causing the prolapse. And a biopsy to ascertain if the mass was cancerous.

Now you don't have to follow the advice. That's entirely up to you and your mother. Sounds like the gynecologist prescribed/inserted a pessary. If you don't want any further treatment, don't make any further appointments. But if the gynecologist suspected a tumor, possibly cancerous, what was recommended would be the expected standard of care in this situation. If the gynecologist found abnormal cells or a mass of unknown type and made no recommendation for further testing, that would be malpractice.

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I'll tell you this; at 90, my father was SO traumatized by an MRI of his brain, I refused to get him further MRIs as was suggested he have every few MONTHS by his doctors due to a brain tumor. The tumor was going to kill him one way or another, so what was the point of furthering his pain & anguish?

My Uncle George was diagnosed with pancreatic cancer at 98; the 'slow growing kind', which I never heard of. He just turned 100. He's done nothing about the cancer, and it hasn't killed him yet.

My motto is this: allow the very elderly to live what's left of their lives in peace and with as little pain & trauma as possible. If this issue is causing your mother pain, and the procedure will not cause her more pain than it cures, go ahead. If not, don't do it.

Good luck!

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I would tell them a solid NO to the biopsy. Tell them that you will not be treating any cancers that would show up either surgically or with chemo and that you would request palliative and hospice care in case of any cancer, so that there is no need to do this test, and you as POA are refusing same. I would accept the pessary for comfort sake and to prevent infection, and etc. Tell Mom she is right up there with the likes of Queen Victoria, who after all her children suffered throughout her elder years with a seriously prolapsed uterus. I wish you the best.

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At her age a Pessary is ideal choice, but remember to have it washed and reinserted from time to time 4-6 months and use a estrogen cream or tablet as well.

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Mom was 92 when she developed tongue cancer. I didn't want her to choke todeath. So she did have an operation to remove large growth in her tongue. Had about 3 months of rehab. Learning to talk, eat, etc. 4th month the cancer moved into her neck. We were not going to put her thru chemo or radiation. 5th month after convincing doctor to write prescription for hospice. She signed the papers and died a week later. I prolonged her life 6 extra months, but she did suffer. Hindsight.

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Don't Do It!
It would probably kill her to go thru it.
Juse keep her comfortable.

My Dad will be 97 next month and when he ended up in the Hospital because he couldn't urinate, they wanted to do all kinds of tests on him and the only thing I let them do is put a Cathiter in him and give him fluids for being dehydrated and antibiotics.

I told them No to all procedures and Test they cane up with because I told them no reason to do tests because he was too old fir any procedure.

I guess it's just their job (Hospital) Policy, to ask you to do these things like going thru a Drive Thru and have them ask if you want fries or a pie with your order.

When you go to a Hospital, you most definitely need an Advicate.

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Good call! Also remember, it's the elderly that are used for 'practice'!

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Our first cousin had the same problem. Going to the doctors office and having the insertion performed-my answer is a big NO NO. Aunt Lorraine as we called her lived until she passed away at the age of 94. Her gynecologist after a visit of excruciating pain for Aunt Lorraine told us to stop the visits.

Hope this is helpful.

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At 97 the only procedures your mother should be having are ones that will help with pain management if she is in pain.
Considering her age and that she has dementia, don't put her through the ultrasound and biopsy and everything else. If she's in pain and it can be managed with medication then that's the most they should be doing for her.

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Is your mother ambulatory?

My mom, 91, with dementia, had a prolapse and got a pessary a few years ago. It had to be taken out and cleaned by a nurse practitioner on a regular basis -which Mom hated. Being in stirrups, she was very uncomfortable (emotionally)with the whole situation.

We had the pessary removed for the last time and kept out after Mom broke her back. She was no longer ambulatory the way she was, and the prolapse works with gravity. Now she spends most of her days seated or laying down and it hasn't been an issue.

Also, she's had 4 skin cancers and we've stopped taking her for check up on those things. Because, why? Same as you, we're not going to put her through any kind of surgery or aggressive treatments, she doesn't want that either. So why put her through the visit. The going out somewhere she's unfamiliar with for something she doesn't entirely understand to be seen by someone she will probably not remember. It just ruins the whole day.

Unless she is bothered by the prolapse, at 97, I'd skip the pessary (which would also mean multiple follow up visits) and the biopsy. I only opt for Mom's comfort as a priority these days.

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I too do not encourage the dermatologist for my mother...I am a full believer that mans medicine gets in the way of God’s plan sometimes...

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A friend had a uterine prolapse in her late 40's. She and her husband were at a remove boat in camp and her vagina with her uterus inside of it was hanging between her legs. It was a medical emergency and a 2 hour boat ride to the nearest medical treatment. I am guessing Mum's prolapse was noted when the nurse was bathing her or perhaps changing her is she is in Depends. This means it is severe enough to be bulging at her Vulva.

So yes for the pessary, but no for biopsies and pelvic ultrasound.

Although my Granny in Law had a full hysterectomy when she was 93 and lived 4 more years. But she did not have any radiation or chemo.

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At 97 I would have her given any medication for pain and sleep and if applicable palliative care but no I would not put her through all that at 97

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IMO too many of you see 97 and immediately segue to the belief that means end of life. I've learned from experience that people can live a long time in an extremely compromised state, my own mother spent 18 months in the nursing home as physically dependent as a newborn infant and she was not the only one there in that condition, some had been there before her and were still there when she died at age 99. There are different levels of prolapse of course but having your uterus hanging out between your legs is not something to shrug off at any age.

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If you mom is having difficulties with urination and/or defecation or is uncomfortable... she would need some treatment. Since it appears she is not having any of these problems - given her advanced age and dementia - I would suggest doing anything. Just keep an eye open for problems with elimination and discomfort. If those do become problems, then a pessary would be the only invasive treatment to opt for.

By the way, I had Gyn surgery via the vagina and I was uncomfortable for about 2 months. I also was on the verge of developing C. Diff. infection from over-prescription of antibiotics after surgery. Keep this in mind if you decide to go with surgery.

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My 84 year old mother with early dementia managed with a prolapsed uterus for years and years and we struggled with a pessary for a year or so but it was too difficult. She finally had a surgical procedure called colpocleisis, where they tack the vaginal walls together with stitches so the uterus cannot fall down into the vagina any more. It does not utilize mesh so there are no foreign materials introduced (except for the sutures and those dissolve over time). Obviously this is only suggested for women who are no longer sexually active. I asked the gynecologist for a "twilight" sort of anesthesia as I had read about the risks of deep anesthesia on dementia patients but she did still develop delirium in the hospital and I noticed an acceleration of her dementia after the hospitalization. I would recommend you just try to keep your mom comfortable with as little interference as possible.

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Having at one used a pessary for medical issues and knowing the difficulties associated with using it and keeping it clean, I would NOT put this poor soul through that, or you, for that matter. Keep her comfortable and clean as best you can but do not do this. It will cause trauma and confusion and at this age, just leave her in peace.

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Don’t do that. Why would you put your Mom under an operation that’s not life saving. I wouldn’t even suggest that, at her age & condition, even if it was a life saving op. The anesthesia will do more harm & could kill her. And .....we don’t allow mercy killing here in USA. Good luck

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Do you even know what a pessary is? There is no operation involved

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At her age I wouldn't do anything unless it would relieve any pain or discomfort. My GM was 96 or 97 when they discovered a lump in her breast. My mother was already a breast cancer survivor as was one of GMs sisters. No one in the family was in any way disposed to have GM further poked, prodded or cut into. Let your mother's remaining days be free from any unnecessary procedures; by unnecessary procedures, I mean anything other keeping her as free from pain and as comfortable as she can be.

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Imho, I cannot advocate for a procedure or testing that could be detrimental to her health.

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emmysfriend,

IMHO, the pessary is the best option. At her age biopsies and ultrasound seems unnecessary!

It's a very simple GYN appointment, but maybe a little uncomfortable during the fitting.
Unfortunately, it does require regular cleaning.
Have you asked what the possible complication are if you choose to leave it alone?

I assume given Moms age and prolapse uterus that she has major incontinence issues. The pessary may help a little.

God bless you for caring for her as you do!!

She's blessed to have you!!

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No to biopsies and ultra sound! She is 97 and should be allowed some comfort and peace. Pessary seems best

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You are certainly correct about not having a biopsy or ultrasound.
How far was her uterus prolapsed? Ask if a pessary would correct her incontinence. Does your Mom walk? If yes, does the uterus drop far enough for the cervix to protrude outside her vagina?
Sounds like she was sent to the ER without an emergency?
Remember when a procedure , especially an operation, is recommended, ask important questions such as:
How will this help her/him?
What will happen if is is not done? How soon.
Is there an alternative approach?
If your parent was in similar condition, would you have it done on them?

Also: It would be great if your parent had a physician’s directive for you.
Do you have one on yourself?

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Should my mother have a pessary inserted, undergo a pelvic ultrasound and get a biopsy of her cervix?

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