Q: After eight children, I have uterine prolapse. I have tried Kegel exercises and pills. I am in contact with a gynecologist and urologist. The urologist thinks maybe it is time for surgery. The gynecologist is hesitant (I think because of my age, 79). I have been suffering for four years now. Pessary did not work. The urologist says he has done surgery on older people than me (needs to tie up bladder), but says the gynecologist will have to do her thing first. I have had surgeries before and have done well, but the gynecologist scares me to death, telling me about the risks associated with the surgery. My quality of life is terrible. I am thinking about having the surgery sometime in May. Since you work with older people, your opinion may help. I am so undecided. — Dorothea

A: You are a very brave and wise person. You have a true dilemma here and I will try to help you as much as I can. Your question really is: how can an aging person minimize the risk and the stress of a surgery?

Well, you have touched on some of the answers already. First, there are two major groups of risk for any surgery, patient-dependent and surgery-dependent. Let me explain about the surgery first. Not all of them are equally risky. Emergent surgery, for example, has a three-fold risk of non-emergent intervention. Therefore, if at all possible, one should opt for elective (scheduled) one. Surgeries are divided into three major groups when it comes to their duration and potential risk for

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patients. The most risky ones are the ones involving heart and major blood vessels, like bypass or aortic aneurysm (bulge) repair. The "in the middle" ones would include both of your surgeries (hysterectomy and bladder suspension), gall bladder, hip and knee replacements and so on. The lowest-risk surgeries would be cataract and laser vision correction. The next thing you have already done — exploring all nonsurgical options. Very often they will be successful and surgery may not be needed after all! You also have mentioned your quality of life. This is very important as well. The benefit of surgery has to outweigh the risk and surgery needs to result in true functional improvement of a person's life. When talking with your doctor it is very crucial to bring up this specific issue. Having the surgery done by a doctor you trust who has experience with it and in the center performing many of these surgeries will also lower the risk of potential complications. One may also consider asking for a second opinion. At the end you need to feel at ease with both doctors you will be working with.

Now, when it comes to patient-dependent risks, multiple factors play a role. Your overall functional capacity is probably the single most important predictor of your success. Very frail patients tend to fare much worse than independent ones. People with memory loss have a higher risk for after-surgery confusion. For patients with previous heart trouble, like heart attack, there may be a need for a specialist (cardiologist) consultation, stress test and some changes of the medications the patient takes. Smokers and people with chronic lung problems have to be monitored for lung-related complications. If at all possible, it is very helpful to stop smoking about six weeks before surgery. All medications the person takes have to be reviewed by your primary doctor and an updated list needs to be available for the surgeons and hospital staff. Certain medications need to be stopped: aspirin, other blood thinners, ginkgo biloba, ginseng, garlic, extra Vitamin E and even some arthritis drugs, since they may prolong the surgery related bleeding. Once you have decided on surgery, follow these steps: pay all of your bills and monthly payments in advance; talk with family, friends and caregivers to support you during the first weeks after surgery; prepare your house by removing rugs, installing grab bars, placing chairs conveniently, and stocking up on easily cooked or microwavable food. Have someone take care of your pet. Get a haircut (and a pedicure). I know you may be laughing now, but pampering yourself now will pay off later when you will not have time to focus on such details. Dorothea, talk both surgeries over with both of your specialists. Ask specifically what their worries are. If still undecided, seek a second opinion. I personally believe that you will be fine and that you should "go for it," but it is you who has to be convinced. Best of luck!

Dr. Beata Skudlarska is a Bridgeport geriatrician. Send questions to Bridgeport Hospital Center for Geriatrics, 95 Armory Road, Stratford CT 06614 or geriatricmd@aol.com.