84 year old 'pre-hab' for major surgery

[Catladyagain]

Hi all, my 84 year old father is booked for major surgery to remove a colon cancer tumour. The team just postponed it because he is weak after a year of internal bleeding and poor oxygen levels. Dad said afterwards "I thought the operation would be a bit like dealing with a bit of a cold. I had no.idea it was so serious". He also could not get his head around the fact the anaesthetist basically said life is very likely to be different / outcomes leaving him worse off than before the operation. He sees a period of recovery then he becomes his 70 year old self again. He does not have dementia but he has always been extremely good at believing what he wants to believe and disregarding any facts. That said he has very poor oxygen levels and you can see his brain is working very slowly and struggling to process everything. I have moved him into my house to 'prehab' him with more protein and trying to build up some muscles but it feels an almost impossible task as he lacks all his earlier energy. But anaesthetist says 6 weeks strengthening can offer significantly better outcomes. Likely outcomes sound horrific and I just don't know how to discuss this with dad. Has anyone else experienced anything similar? Thanks in advance.

What does pre hab mean ?

Sorry!! it is pre-habilitation, which is building up his health - muscles and fitness and nutrition, ahead of the op. Thanks for raising the question.

As in the OP, optimising the patient's condition before a procedure, in order to get the best odds possible of a good outcome. Can involve diet, optimising weight, stopping smoking, exercise, iron/B12 etc supplements if deficient, basically trying to improve odds of a decent survival.

Did you read the OP?

It's care, designed to build health, strength and, if possible, fitness before undergoing major surgery. Like rehab, but happening before the operation rather than after it.

I think the most important thing is that your dad, and the family, have a clear understanding of likely outcomes, as that is essential for proper consent. Pre hab is a relatively new concept, so the team promoting this is a good sign that they really want the best outcome.

No apology necessary; it's entirely clear what you meant.

Well it wasn't clear to me.
Thanks to OP for explaining it.
I have never heard of it and wondered if it was a typo in the OP which confused me.

Thank you all for helping me out. @nocoolnamesleft actually they didn't bring it up - I did. I'm 44 and now slightly obsessive about the need to physically prepare for old age and my dad has landed squarely as proof of need. Interestingly the anaesthetist was quite surprised at me asking, wondering if I'm a medic (I'm not even close) and admitted he'd been fighting for more funding for pre-hab, which they had literally just got approval on. And presumably the doctors will quietly be wanting to save these resources for younger folk. my dad has taken zero interest in his health all his life but has always been a very active man so never had to think about it. His diet for 20 years has largely been microwave meals and biscuits.

Bloody well done you, then. I'm glad your dad has you on his side.

@Catladyagain
you sound like a lovely daughter, wanting the best for your Dad. I hope the pre-jab and op goes well for him. Sending love.

Pre-hab
NOT jab - predictive text at its worst!

thanks so much for your sweet words.
Unfortunately It's one thing having an idea of what we need to and another putting them into action. Building healthier habits for any of us is such a challenge. Have to try! x

Would he eat porridge ?
Quaker Oats do sachets that you empty into a bowl then fill the sachet with milk or water.
Mix and ping for 2 mins.
They also do a larger serving called Big Bowl.
He might be more amenable to it if he sees it utilises the microwave.

Then when cooked add a little Greek yogurt
Mixed seeds
Cashew nuts
Raspberries
Blueberries
Cherries.
Worth a try.
Good nutrition.
All the best.

Surely in order to consent to the surgery he needs to have the impacts including the recovery period, the likely benefits of surgery and the consequences of not having the surgery explained clearly to him - either by you or the surgery team or by both of you - so that he has full knowledge of what he is about to undergo. Nothing is going to turn back time 15 years and especially not major colon surgery.

Given his health up to this point and that he now has cancer do you and the medical team each wholeheartedly agree the surgery will have sufficient long term benefits for it to be worth him undergoing it? Will he also need chemotherapy or radiotherapy and does he understand this? If he is not able to process what the operation entails and how the recovery will be and currently isn’t strong enough to undergo the surgery anyway, then his future seems potentially poor quality from both a physical and mental perspective. My mum died recently at 93 and the last 1-2 years were very much poor quality of life. I believe in quality of life and not simply quantity of life. I am not sure at 84 with poor cognition and in a weak state that I would want major cancer surgery for myself. I am sorry for what you are going through.

My cousin was 84 when she was diagnosed, stage 4. She had not been in pain or bled a lot, just constipated. Everything was explained to her and she was given choices. She chose not to do anything and died peacefully.

My DH was going to go to the hospital for a prehab course to prepare him for a Whipple’s op. Sadly he died before he’d had chance to attend.

Are they offering anything at the hospital OP? My DH was going to get physio and cardio to get him fitter.

@Catladyagain "He also could not get his head around the fact the anaesthetist basically said life is very likely to be different / outcomes leaving him worse off than before the operation."

very gently, are you sure this is right for him? I think you need to think about the reality of it as well as him.

It’s a very difficult decision, to have major surgery in your 80’s. I would consider his mobility, unfortunately a lot of elderly patients mobility really suffers after a spell in hospital, also risk of delirium which is very distressing to witness.

i can only speak from experience, my late MIL, 86, had breast cancer, SIL did not want her to have surgery, as she was concerned the cancer would spread, she worked in a clinical profession.

MIL decided to have the surgery, very sadly after the op the cancer spread very quickly, she was a very fit lady before, she became depressed after the op, recovery was slow, had radiotherapy but sadly didn’t help. I miss her every day, we were very close.

i am so sorry for what you and your dad are going through, I do hope he has a better outcome. Wishing you all the very best.

Major bowel surgery can have a long and painful recovery period. I know someone who had a major bowel op as a physically fit 18 year old and the recovery involved 6 months of pain and readmission to hospital and complications. It could be much worse for an elderly person. Do ask the doctors what recovery would look like and if this is im your dads best interest.

I wouldn’t have the op.
My beloved dad spent 3 months in hospital after a cancer op and he was younger (77) and very fit. He never really recovered and died a year later.
I’d be looking at palliative options and asking about chemo and immunotherapy. It’s bloody awful, I’m sorry.

(Not the same, but there was an article on some bit of radio 4 a few weeks back about pre-hab for hip replacements. (or maybe knees). The doctor said a good % of her patients who did pre-hab ended up not even needing the operation.)

There was also a whole R4 'Food Programme' on eating to help recover from cancer on 19/6/26.

Best wishes

@Roselilly36 do you mean operations in themselves can cause cancer to spread? I've never heard this before. His was thought for months to be a polyp and because it was so flat they missed it was cancer. Apparently it's very slow growing but its gone from 18mm or so to 3 or 5cm in the last 6 or so months. I'm realising I need to see it's rate of growth and double check this. No one has spoken of chemo or radio but they've said theyll check the lymph nodes. I feel they've been awfully vague. My brother was at the appointment where they told him it was cancer and he said it felt they were really trying to suggest no operation but clearly risks were not discussed.

Should I try to get us a 2nd opinion from a private colorectal consultant? Not exactly sure what I'm even asking them - I just want my dad to hear about all of it in a different way that perhaps helps him get a better picture of everything.

Thank you all so much for your generous replies.

I wouldn’t go down this road. My 84 year old FIL was given chemo for two lots of cancer, one stage 4. Why? He passed away during a battery of futile tests, procedures and treatments. Without sounding harsh, we don’t seem to want to allow old, frail people to just die anymore. Nurse of 37 years.

I don;t think that's wat @Roselilly36 meant - it;s certainly not something I've ever heard of.

however, if your father has the operation they can then analyse the tumour and also look at the surrounding lymph nodes, and depending on what they that might indicate that further adjuvant treatment such as chemotherapy might be beneficial

I've had bowel cancer , although I was twenty years younger than your father when they operated. It is a major op (mine took around 6 hours apparently) and it will take at least several months to recover - some find that their bowel movements never return to 'normal' and there are certain foods they can no longer tolerate. And there is the possibility that you could end up with either a temporary or permanent stoma.

The surgeons and anaesthetists were very good at running through all the risks and outcomes but there are so many 'worst case scenarios' that they have to mention that I found it difficult to get my head around.

However I think that there is an issue with bowel cancer that if left untreated the tumour may eventually get large enough to block the bowel, and that could require a similar unplanned emergency operation at short notice.

I wish you and your father well.