Foot amputation

easy23

My 71 yo DH is stage 6 and has lived in MC since Sept. 2024. In November, a podiatrist clipped his toenails. A few days later his big toe developed gangrene. I took him to the hospital's wound care center and they tried to clear up the gangrene with Santyl, but it didn't work. The gangrene spread down the toe.

A Doppler showed DH had poor circulation in his leg and foot. My DH developed cellulitis and had to be hospitalized. The toe was amputated. A vascular surgeon cleared a blockage in his leg and determined that there was nothing that can be done for the poor circulation in his foot.

Now the wound is slow to heal and the four remaining toes are dusky colored. The podiatrist is skeptical that there is enough circulation and feels my DH will probably need a foot amputation.

Has anyone had a similar situation and how did you handle it? If my DH has his foot amputated should I move him to a nursing home instead of the MC? Should I get a second opinion?

marier

I am so sorry you and your loved one is having to deal with this awful situation. I would definitely get a second opinion as soon as possible. Hugs and prayers to you.

Carl46

I agree, a second opinion is warranted. If he needs amputation, he probably will need NH for skilled wound care, at least until the wound heals, and probably thereafter if he can't become ambulatory.

CampCarol

I would definitely get a 2nd opinion. Re: NH vs MC, I would think you need to see if your MC is equipped to handle a patient with this condition, some can. And he will probably also need some kind of interim rehab post surgery.

jsps139_

How awful for him and you. That’s a lot to deal with. I pray something can be done instead of amputation.

Vitruvius

There may be a bigger issue here. For one thing, if he isn’t on hospice yet you should probably have him assessed for it. My DW is in Stage 7f and her feet and toes are not getting enough circulation and hospice is now afraid of gangrene. They have explained to me that as dementia causes the brain and body to shut down, it causes blood allocation to be directed to core organs and this will accelerate. I’m not saying that this is what is happening to your DH. I’m just suggesting that you look at what is happening on a broader level than just his feet and that hospice can help you do that. I’m sorry if this sounds alarmist.

housefinch

I’m imagining him, if he gets an amputation, not remembering the surgery. I’m wondering if he would be recurrently traumatized discovering each morning that he is missing a foot. Would he be incredibly upset every day? Similar to regrieving a death because he forgot a relative had died, except you can’t hide a missing body part. It’s possible that, as he progresses, that reaction would improve. I would also consider asking the vascular surgeon what his heart and aorta probably look like if his foot’s circulation is so poor. The answer may help you decide about the amputation (eg if he has the same level of vascular disease in his heart and aorta, you might not be gaining him much time by doing the amputation).

Jgirl57

How awful for you and your DH. I agree with Vitruvius about hospice and the decline of circulation . You already know it is not going to improve. So very sorry you are faced with this decision . (((Hugs)))

easy23

Thank you all for your insight. You've given me much to think about. I wasn't aware of the tie in between poor circulation and dementia. I'm going to start with a second opinion with a highly experienced vascular surgeon on Monday and take it from there.

@marier @Carl46 @CampCarol @jsps139_ @Vitruvius @Jgirl57 @housefinch