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Alan Heldman MD's avatar

When transcatheter aortic valve replacement was brand new our hospital was the only place in Florida that did it, and I saw lots and lots of very old patients with severe aortic valve disease. They came with their concerned children, many of whom were themselves doctors and nurses. These patients were among the last of the Greatest Generation, the ones who saved the world. I'm eternally grateful for what I learned from

those wise old folks and their thoughtful children. A completely rational 94 year old might decide to have a procedure, and another equally rational 94 year old with slightly different priorities or values might decide to decline. Especially at that age, folks have earned the right to make their own choices!

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Michael Kirsch, MD's avatar

Alan, thx so much for your insight here. I have had the same experience in my practice over these past decades as well as in my own family. Nonagenarians rely upon a different playbook in medicine and in life. Thx for reaching out.

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William M. Seymour's avatar

Once a resistor, have had procedure at 50, 60 and 66 yr (week before last). And yes, I have had some unkind thoughts about the medical profession during the prep. At 60 yr 3 benign growth removed; this time 1 benign removed and learned that I have diverticulosis. I want to be here for spouse, 2 children, 6 grandchildren so I am glad to have had these removed. But I understand the issue with acceptance. Question/observation: is the purging of the G.I. tract beneficial in and of itself? It seems to be in my case. Similar to “cleansing” or “purging” routines offered at health retreats? Does colonoscopy reset the colonic microbiome, or vanquish, at least temporarily, dysbiotic yeasts/fungi?

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Michael Kirsch, MD's avatar

Hi William, thanks for reaching out. As you point out, there is an industry devoted to colonic cleansing with the promise of assorted medical benefits. My own view is the promise of benefit far exceeds persuasive medical evidence. I have never engaged in it or recommended it. You might find the following link of interest. I wish you well. https://mdwhistleblower.blogspot.com/2019/10/colonic-hydrotherapy-is-it-time-to-bend.html

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William M. Seymour's avatar

Thank you Doctor for both these articles.

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Dr Arif Hussenbux MBBS's avatar

Brilliant article. Choosing the right words to describe consent helps frame that process in our minds.

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Michael Kirsch, MD's avatar

Thx so much, Arif. I appreciate your taking the time to read and comment.

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