My dad is amputee with dementia. His "stump" needs revision surgery because the bone is about to come out. Too risky?

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I have already posted a few questions, but I actually have a new problem (they seem to be unending at the present time). My father had his leg amputated late last year (a couple of days before new year's day). Now the bone is about to break the skin and protrude (if it hasn't already), and he needs surgery to correct his. I have not yet spoken to the doctor. He called and left a message saying that he needed to know what I WANTED TO DO about it. I guess I am going to be given a choice??? The concern is his numerous health problems and his advanced dementia. He is at a high risk for surgery (not a good candidate by any means). He pulled through the amputation and he was in not-so-good shape then, but he is even worse now. I mean he is looking frail. I just got a call from the NH on Monday/Tuesday saying that he was eligible for Hospice, and that means that they think he only has about 6 months to live. They are picking him up because of his advance dementia. I was told they could do the surgery while he is on hospice for comfort and pain measures, but his other leg may eventually need amputation as well (not now, though - and he may not live long enough for that). What should I do? Does anyone think they are going to ask me if I want him to have the revision surgery? I guess it is questionable and RISKY because of his health. If they are giving me a choice (I am his POA), then does anyone have any advice to share about what they think I should do? This is a no win situation. He keeps losing weight, and if he has more surgery, I guess the bone could very well protrude again and so on. What should I do?

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By the way, knowing my father, he would be EXTREMELY AGITATED if he were in pain. Right now, he is as gentle as a lamb. We saw him Monday, and he was peaceful and didn't try to fight us or resist drinking the shake that we bought for him (as usual). He was under pain meds, no doubt BUT he greedily grabbed that shake just like and kid and would get A LITTLE impatient when it was taken away from him just for a moment. He drank the whole thing. This was in sharp contrast to the weekend before where he hit everyone who even touched him tried to feed him. So, he is peaceful now and that is a good thing. If he is in pain, he lets everyone know about it. Really he does.
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It was actually the nurses in the nursing home that were insisting that he had to have surgery right away. The doctor and nurse at the vascular clinic insist strongly that he should NOT have surgery at this time because doing so will case him more pain and suffering, and his body may not heal from the surgery and there is a risk of infection that goes with the surgery. I appreciate everyone's thoughtful comments and advice, but I think it best to leave it at that unless something changes again. I really don't want him to suffer any more. He is peaceful at present.
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Spoke with his doctor today. Surprisingly, once again the doc said it is not the best idea to operate because the surgery will cause him more pain and risk of infection. Really, what he says makes sense to me. It does. He is under hospice at present. I do NOT want to get too personal about his wishes and what is in his advanced health care directive, but I will say that it made it clear when he was in a good mind that he DID NOT want to be put on any kind of life support or have feeding tubes put in him. He said that he wanted his DEATH TO OCCUR NATURALLY. The doctor has said that we should make him as comfortable as possible at this time and not cause him any more pain and suffering - as another surgery will. He appears to be PEACEFUL. Sometimes he has clear, lucid moments and makes sense (he even knows who I am responds to me when I tell him that I love him "by saying "I love you"), and he does not indicate that he is in pain. The doctor has said on more than one occasion that "less is more" in my father's case. We do not want to prolong his pain. If it becomes critical that we absolutely have his leg operated on, then we will no question.
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What were your dad's wishes when he was cognitive enough to discuss them with you? (My 92 year old dad has dementia, and when he discussed cryonics with me throughout his younger years, however, that is not an option.) Now, dad's goal is to live to be 100 years old. I made the mistake of putting dad in an assisted living facility here in FL, and they almost neglected him to death by not administering his medications as ordered. But, he is home with me now, eating like there is no tomorrow, and he has surprised me with his cognitive skills on a daily bais!
However, concerning your dad, if the bone is exposed, it needs to be medically taken care of due to the risk of osteomyelitis that will effect other bones in his body. In my past experience as a RN (before I became disabled), the majority of competent physicians would use a local or spinal anesthetic on elderly patients whenever possible due to the all the risks related to general anesthesia. And, as far as pain is concerned, I believe that even although an individual is in the end stages of dementia or Alzheimer's can still FEEL pain.
My mother passed away in a nursing facility from complications of Alzheimer's and heart disease. Every visit with mom was a heartbreaking experience because every time the staff re-positioned her, she would cry out in pain. But, mom never lost her great sense of humor, even prior to her death, I could tell her a joke, and she would laugh so hard that she would have "tears of laughter." And, she NEVER forgot how to lovingly stroke my hair and give me a kiss right up until the very end of her life.
Just hang in there childofvet, and do what you think that your dad would want you to do!
God Bless!
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With any luck the revision surgery will be no more painful than the existing wound, and might even be better as fewer nerves will be exposed now. A bone infection wasn't going to be a walk in the park for him either. Let's hope for good healing.
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Thanks again to everyone who has commented and offered their advice. Actually, my husband and I visited my dad again today and I spoke with four nurses: the hospice nurse who happened to be there, and the wound care nurses who are taking care of his wounds. I also spoke with another one who called me early in the morning to discuss what the plans were regarding his revision surgery. I should have known better...he WILL definitely have to have revision done. The bone is protruding now through the skin and something must be done. I will talk again with the doctor tomorrow (I am sure), and discuss it more, but I think he will have to have an epidural instead of general anesthesia. I will know more pretty soon. I cannot see us having to amputate the other limb (or perform a bypass on it), though. I was told that it can't be amputated (or operated on) if he is under hospice care - only the revision surgery can be done. The other leg does not need to be amputated or surgery at this point, but I was told that the circulation in it is not normal. There is also an ulcer developing on it as well - it is doing what the other leg did initially. My father did have a bypass on his leg during the spring of 2011, but that bypass didn't work (failed) and he ended up having to have the leg amputated in December of 2012. I cannot see him going through a bypass on his leg again or another amputation - that would be too cruel in my opinion. Best to let him go in peace and not put him through that. But as I said, we must do the revision on the stump. I am not happy or optimistic about the outcome. It all seems so terrible.
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If you've consulted with your doctor (& nurses) you've done your part. If he has no quality of life, you need to be strong and let him go. That will be hard to do, but worse to make his life even harder by having another procedure (IMO). You're doing the best you can.Be strong. Prayers for him, you and your family. Blessings.
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I don't think it'll be too risky. Expensive maybe. Something tells me skin graphing may be involved..
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"They don't come through the anesthesia well," is what our family doctor said when I told him a local surgeon wanted to operate to repair deterioration to my 93-year-old mothers' 18-year-old prosthetic hip. The doctor has a lot of elderly patients, plus is on call for a nursing home. He said her dementia could get drastically worse after surgery. We went back to the original surgeon at a large regional clinic and she strongly advised against the operation as being too risky on a number of levels, even if only a spinal was used and non-narcotic pain killers. In the end, Mom's muscles compensated for the hip damage and she now is able to walk unassisted. (That's not always a good thing from the caregiver point of view, but I wouldn't have taken that away from her no matter how much trouble she gets into.) That's a good choice to let dad rest in peace, as far as that's possible given his agitation. God bless.
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are you also is mpoa? how old is he? does he have a living will? My suggestion is if he is in hospice, don't put him through anymore surgery, let them keep him very drugged so he is not in pain and can pass on to heaven in peace, my heart goes out to you and will keep you and your dad in my prayers
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