Granny has dementia and gangrene. Anyone have experience with this?

She either needs to choose to be enrolled in hospice (because gangrene is fatal and hospice has access to the good pain meds) or her POA needs to override her choice for no treatment because she obviously isn't capable of understanding.

Your grandmother is not grasping how deadly this is. Maybe show her some photos of gangrene so she can maybe see it for herself. Do you know someone in the medical field who can come by and talk sense into her?

I kinda get not wanting to treat.
An amputation would require wound care as well as a possible stint in rehab. I do not know how your great grandma would participate in rehab. So that might not even be offered.
Without rehab your grandma is going to be doing a LOT more care. Can she manage that?

Not amputating the gangrene will get worse and it is fatal.
Contacting a Hospice of their choice would be the option then.
Pain can be managed effectively at home and if it can't great grandma can be admitted to the In patient Unit where they can manage pain and other symptoms that she may have.

The person that is POA would be the one to make this decision. Hopefully it would be a decision based not only on what great grandma's wishes would be but also taking into consideration the dementia and the chances of a good quality of life that remains.
Your grandma should discuss this with great grandma's doctor so she can get all the information she needs to make a truly informed decision.

If you do not agree you could file a petition to become great grandma's Guardian. This can take time, although with a life threatening condition it may go quickly.

Gangrene is fatal. It is a horrible death. I watched my grandmother die of gangrene back in 1976.

Does your grandmother understand that this is fatal?

Can you get the names of some hospice organizations for him to call?

Pain can be determined by monitoring BP. Hospice can show you how to do this.

You should know that the stench is going to be awful for many weeks. Face masks, with Vicks Vapor rub under the nose will help.

My guess is that no one has POA and that your grandmother is great granny's defacto surrogate by virtue of being her daughter i.e. her next of kin. Is that correct?

If the gangrene is not treated, the bacteria will spread and sepsis will set in. Your great-grandmother will get very very sick but more than likely it will be too late even if she got to the hospital.

You need to explain to your grandmother that great-granny either gets to the hospital sooner to have a few toes removed and goes home (she does not have to go to rehab which with her dementia will only distress her) or she gets to the hospital later in full-blown septic shock, which is an ugly way to die.

If your grandmother wants her mother to have a nice quality of life at home until she dies, gangrene is NOT the way to go. That's not to say there aren't risks with amputation - general anesthesia, etc. - but at this point, the real choice is between a few toes and death by sepsis.

I’m a little confused here about your statement that your granny has a blood clot and she got gangrene in her toe. I thought gangrene occurs when a person has diabetes. When it comes to a blood clot, it can travel to your granny’s lung or heart and cause her to die instantly. I had a cousin who had diabetes and he had a cut on his toe which he did not take care of and which eventually developed into gangrene in his leg because it had spread. The doctor advised him that they needed to amputate the leg in order to save his life. My cousin refused to have his leg amputated because of his pride when he said he’d rather die than have his leg amputated. My cousin eventually died from the gangrene at a very young age when he was in his 50s.

Having a blood clot and having gangrene are deadly illnesses, and your granny needs immediate medical attention. I had a blood clot in my leg and the doctors had to place an IVC filter to prevent the clot from spreading to my lung or heart.

Judas freaking priest, call an ambulance and get her to a hospital. I can't believe you are trying to get permission from someone with dementia while their body is literally rotting away in front of you.

Granny is up there age wise and has Dementia. Maybe the daughter feels just let nature take its course at this point. Has granny seen a doctor? If not, grandmom could get in trouble for abuse since she is the main Caregiver. This is a life threatening disease that can be cured. I agree, you call the ambulance.

This is in the hands of the person responsible for great-grandmother. The gangrene not only kills, but it does do so slowly and painfully, with a malodorous condition that will make the home or premises where great-grandmother lives almost impossible to live in. By the time there is oozing and odor the spread may be able to be stopped. I am assuming that your great-grandmother was seen by medical, and given grandmother's unrealistic attitude that there is no talk of Hospice care?

I am so sorry this is happening. I suspect you have done all that can be done by you.
However, at this point, as to pain, watching for grimacing or groaning with pressure to the foot would be your best bet in order to know. Often in conditions this bad there is little pain in someone very elderly due to peripheral vascular insufficiency. This insufficiency cause a sort of numbness in the feet that in this particular instance may be a bit of a mercy.

Do know that surgery is dangerous not only to losing toes but to losing life at this age, and that given dreadful circulation issues common at this age, there may be no healing, a need for further amputations, and it could spell the beginning of the end no matter WHAT is done now.

I am so very sorry. If you are very involved and wish to be, attend MD appointments with grandmother and great-grandmother if you are allowed and ask questions about options. My heart goes out to you; I hope you'll update us.

If you call 911 and they take her to the ER and (probably) admit her to the hospital be sure they know she is an "unsafe discharge" and talk to a social worker at the hospital so they can get her transitioned directly into a facility (if great grandma makes it that far). Make sure that Grandma doesn't go to the hospital and sow confusion and attempt to take her back home -- she doesn't seem to know (or care) what she's doing or how it's impacting Great Granny.

Or, call APS and report your Great Granny as a vulnerable adult and be sure to be at the residence when they show up so that Grandma doesn't shoo them away.

If no one is Great Grandma's PoA, then the county will become her guardian and then take over managing all her care.

So sorry about this very distressing situation but the main goal is to get Great Granny treated and minimize her pain, and get her into a better care situation where she isn't endangered.

okay let me give an update! granny had the blood clot back in may, they put a stint in and everything however back in august she was admitted to the hospital she had fell while at my great aunts house and she couldn’t get her up so they admitted her and they wanted to cut her toe my grandma didn’t want to cut so they basically sent her to a nursing home for physical therapy for 3 weeks (she was released from the nursing home the week before halloween) the nursing home have a physical therapist ( twice a week) and a nurse (once a week) come to monitor the gangrene. I have been saying since granny fell that it needs to be cut but i think due to the hierarchy my claims have fell on deaf ears. Now it has spread to her second toe and granny is in a lot of pain, i said what i always said of how it’s best to cut and using the spoiled apple as a way to get them to understand how bad it is and how deadly it could be and still nothing. My older cousin is power of attorney however he’s just as bad as my grandma? granny other children is almost not as interested either? I think i’m the only one who is trying to do something but it’s hard because i am pregnant. I hope this context helps and yes there’s been no mention from drs of hospice and the hospital wanted to take the toe off but then my grandma, i feel like, found a podiatrist that aligned more with her not wanting to cut. Should i still call the ambulance and have them admit her and help her that way?

Even if the decision has been made to not treat leaving someone to experience terrible pain and suffering is cruel and negligent in my opinion, reporting your concern to the nurses, then the doctor, and if necessary ultimately APS is the ethical choice.

Sk, read this:

https://my.clevelandclinic.org/health/diseases/21070-gangrene

A podiatrist is not going to treat gangrene.

If ggma isn't seen soon in the ER, she is going to die of septic shock.

Make sure your cousin the POA knows this

Then decide if you are going to call 911 or discuss with Adult Protective Services that she requires Hospice care.

Grandma does NOT deserve to die in pain. Either Hospital or Hospice.

call Adult protective services. This is medical neglect

skkickss,

I’m so sorry that your great granny has gangrene.

I dated someone who had a horrific motorcycle accident. The accident happened at night so he couldn’t see that a light pole had been knocked down and lying in the street.

When my boyfriend hit the pole he went flying off of his bike and suffered horrendous injuries.

While he was in the hospital he was told that there was nothing they could do to save his arm due to gangrene setting in. Without an amputation he would have died.

He was young, in his early 20’s. He was freaking out over losing his arm and in horrible pain.

He came to terms with the fact that he didn’t have any other choice but to agree to allow the doctor to amputate his arm in order to live.

He went through a lot of physical and emotional pain. It is traumatic to have an amputation.

Your great granny’s age complicates things so much more. She or her POA will have to decide whether they feel that an amputation is worth the risk. Sadly, a decision will have to be made soon, very soon.

Gangrene is extremely painful and is fatal. Removing a toe will affect her ability to balance properly.

I would seriously recommend getting information on hospice organizations because it may not be safe for her to have surgery. Or even if it is, she may not want to face the aftermath of surgery.

Hospice will address the pain that goes along with gangrene. They will also provide a social worker and clergy for your great granny and your entire family.

Again, I am terribly sorry that your great granny and your family are going through this tragic situation. It’s not going to be easy no matter what she or her POA chooses.

Wishing you and your family peace during this challenging and difficult time.

What does sleeping with a “leg up like a tent” mean?

I have no expereince with gangrene or toe or partial foot amputtuions, but gangrene cannot be ignored. Maybe Granny would be more willing to have surgery if she understood about what foot or toe prosthetics would be available for her to help restore balance and stability with missing toes.

I just read ur update on the 17th. IMO, you have no say here. She has a POA who can override her decision if she has been found incompetent. I think everyone knows gangrene is a killer. They are choosing to let her decide. You can tell them the dangers and you can recommend hospice but that is all you can do.

Ur profile says Granny is 88 with Dementia. Please realize that putting her under can cause her Dementia to worsen. Also, seems she is prone to bloodclots which are a problem when operated on. A bloodclot can be thrown to the heart and the person die instantly.
I think with your granny's age and having dementia hospice should be called in and the abuse is not doing this. Hospice will give her morphine for the pain and keep her comfortable.

This situation is another example of why having an advanced directive and a POA is so important.

I can tell you that my grandmother would never have wanted to die in pain. She watched my grandfather suffer in the hospital for months on end. She would often say that she wanted to leave this world quickly and painlessly.

She got exactly what she wanted. She was in good health up until the end of her life. She had a heart attack, died very quickly and was DOA when she arrived at the hospital.

skkickss: This is deemed a medical emergency.

Understand that she has an infection in her foot. She needs the infection treated and to be evaluated by qualified doctors to determine if she will need amputation. Please get her to an ER so she can be evaluated and start IV antibiotics. If not treated, she may (most likely will) develop sepsis - a life-threatening infection that is throughout her body and causes major organs to die.

Please note, this is a great-granddaughter. There is a POA in charge. Granny has said no and seems family is going with her request even though Dementia is involved. OP has no say in the matter. All she can do is suggest. If they are not going to do anything, then Hospice should be brought in.