FIL getting amputation

[bright eyed]

FIL's health has been on a slow decline and they just admitted him to the hospital since his wound is not healing.

He's been in a nursing facility since Oct and had been doing poorly, then a bit better, and poorly again.

Rapidly losing weight, they were considering an NG tube to get him to gain some weight but we held off since he would likely pull it out and lose any good will he was establishing with the staff there.

Not much had been said about his wound lately - he went weekly to a wound clinic for care - now he's back in the hospital and the dr. called and said they want to amputate below the knee.

We visited FIL over the holidays and he is very weak - he can't lift himself to scoot up on the bed - he's having trouble keeping food down etc.

The wound apparently is very infected, gangrene and that is why they want to cut.

He's not a good candidate for surgery in general and going under is not an option - so all of this will happen under a spinal...he's 78 years old.

The whole thing has me concerned about him overall. The only good thought is that the surgery will get rid of the infection - but beyond that I'm very concerned about his ability to heal at all, the pain from the surgery (he is already in pain from the infection)...and mentally how he will deal.

but i guess we are out of options only bad and less bad? anything i should be sure to ask?

only thing i've found is that amputation puts you at risk for further amputation - are we just making a terrible situation worse?

[Rich_by_the_Bay]

Not good. I am guessing he is diabetic and has osteomyelitis, too.

FWIW, general anesthesia is no less safe than spinal, so discuss carefully if you have a preference. You're basically deciding between competing packages of risk: progressive infection if you do nothing, versus operative risk, rehab needs, pain, and other quality issues if he has the surgery.

It's a tough one. Is a third alternative to just provide symptomatic treatment and let things follow their natural course, or is everyone not quite ready for that?

Sorry for your FIL's predicament, and best wishes to you and the family.

[Moemg]

Bright eyed ,
I'm so sorry to hear about your FIL .

[bright eyed]

Thanks Rich and Moemg...

Yes, I think it's the "letting nature take it's course" vs. "doing something" - His son and I are on the fence because we're not sure the amputation would do much good, but his wife thinks they should go for it.

He will not likely be able to participate or refuse to do any rehab - that is my concern - because he has little muscle tone left, he will just be in bed, more depressed and not heal well. He's a very unhealthy 78 year old, so the surgery may just provoke something else to break down...but they have tried everything else in terms of anti-biotics and wound care. so it's this or just "alleviating" pain...

I didn't hear the specific reason about the general just that they ruled it out- I didn't know the spinal wasn't less risky - I will ask, thanks Rich.

[Caroline]

Quote:

His son and I are on the fence because we're not sure the amputation would do much good, but his wife thinks they should go for it.

I'm so sorry to hear this -- it is terrible to watch someone you love decline and be able to do little or nothing to help.

Not to be flip in your time of distress, but what does HE think about this, assuming he is cogent? My FIL died last year from lung cancer. His immediate family didn't want him to go, of course, so in their suffering and fear they hovered around him, nagged him to eat when he didn't want to, and his wife went so far as to slip tranquilizers into his drink when he wasn't watching.

Observing this, I came to conclusion that what I'd try to do for my folks as the end drew near was to support their decision-making, no matter what they decided.

I know that doesn't answer your question, (and I'm not sure how well I will carry it out myself when I face the loss of my parents), but it seemed like a good decision to make last year.

Sometimes there are no good answers... again, I'm sorry.

[Twinkle Toes]

Sorry to hear about your FIL. Sometimes life just sux. I wish the best for your family.

[bright eyed]

his mental condition has sort of been inconclusive - he's had several psych evals but they aren't ever sure and sometimes think it's because of a language barrier - no matter how many times i tell them he understands english just fine.

more recently they have been relying on us to make all the decisions...

caroline - i totally understand where you're coming from. that's why more recently when they started suggesting things like the NG tube etc I started to question how far we would want to go with all of the interventions.

regarding the amputation, he and his wife had discussed it a while ago and he said if that was what he had to do - that was it - however, given his condition, i wavered just because it didn't seem like it would improve him but start another set of issues related to the amputation.

i think there are no good answers for him. i do wish they could do more to alleviate his pain - i'm not sure why they don't...and that is a big concern for me post-operation - after his last surgery (vascular), he was barely tended to, so i called to make sure they checked on him... i'm sure it's all part of an overstretched system.

thanks for your kind thoughts...

[Wags]

Prayer for the Sick
Merciful God, we remember before you all who are sick this day. Give them courage to live with their disease. Help them to face and overcome their fears. Be with them when they are alone or rejected. Comfort them when they are discouraged. And touch them with your healing Spirit that they may find and possess eternal life, now and forever. Amen.

GOD BLESS

[Texas Proud]

Bright Eyed...

Like others, sorry to hear about these problems..

But I will ask.. do you even have a say in the treatment? If he has a wife, does she not have the final say if he is not able to make it? I would think you could have some input, but could not tell the doctors what to do if it was against his or his wife's wishes.

And for almost all the people in my family... quality of life is the most important part of the decision making process. Almost all of us has said if something will not improve the quality of life then do not do it... so in this case, I would have to ask if they did amputate, what is the chance of him living longer than without the operation.. and would his quality of life improve, stay the same or decline... (yes, a small decline in quality with a lot longer life is a good trade off)...

So with this.. if he is only going from one bed to another and in pain all the time and there is no hope of recovery... most all in my family would chose 'let nature take it course' and just make sure they give enough to take away the pain... IMO there is NO reason to be in pain today.

Hope things turn better.

[bright eyed]

They did the surgery last night and he is sleeping and eating.

Tex, i'm the designated contact for the family because i (can attempt to) understand the medical information and bureaucracy then i tell his son, who talks to his mom (in spanish)...so it's complicated. I definitely don't have final say nor would i want to!

there was little time to figure stuff out and trying to get his wife to see any possibility that not doing it was something to consider would have taken more time. hopefully this will clear the infection and relieve some of the suffering - but another side of me is feeling like it may just have traded one suffering for another.

all the info i saw on amputations smoosh all amputees together and given FIL's age and physical/mental condition i would guess he's in the highest risk category...

[Sandy]

Bright eyed

I hope your FIL recovers well. If it seems that he is in pain, the family should insist on more aggressive pain management. You may have to ask more than once, but it is a request they should honor. If you aren't getting anywhere, ask the attending to bring in a specialist who manages pain.

[bright eyed]

thanks sandy - i will definitely be more vigilant on that one, especially in the next few weeks... - i didn' t know he was in a lot of pain until his wife visited him last week...since i am doing this all remotely (he's in northern california).

apparently he's awake, and eating some food so that's good!

[lazygood4nothinbum]

a old friend of mine once described the process of dying as a complicated billing procedure. that's a tough story bright eyed. hang in there.

[samclem]

bright eyed,
Best wishes for your FIL and for all of you. Perhaps the amputation will buy him some time with less pain than would otherwise be the case.

[growing_older]

Much sympathy for a sad and difficult situation. I had older family suffer a medical setback that required considerable rehab to regain some function. In the excellent rehab center, the wonderful staff were able to coax some patients into active attempts at rehab and some just felt sorry for themselves and didn't seem to try much. Hope your FIL finds what he needs in his recovery.