After doing several rounds of tests and consulting three doctors, the best course of action for dad's problem seemed to be to open up the blockage in dad's leg and amputate his toe. The infection was in his bone but had not (has not) gone beyone his toe. That seemed reasonable.
Dad went to the cath lab on Tuesday. The surgeon ran into two totally clogged arteries that he said will never be opened. The third one was bad but might be opened but dad had a small bleed. The surgeon got control of the bleed and shut things down. Dad and I spent a very long night in the hospital Tuesday night and came home around lunchtime yesterday.
Basically, we seem to be back to square one, at least listening to the surgeon. I really dislike the man. He told me on Tuesday that we needed to talk, but when I told him yesterday it was talk time he told me talk time was over that we needed to do something. I get the feeling (but it's difficult to tell with him) that he wants to go ahead and amputate the toe. That's not going to happen with the current state of matters. He turned around and said he might be talked into going back in and trying to open the artery again but he was gloomy about that. Well, this narcissistic a$$ was gloomy about dad being able to be still for the cath lab. He was the one that told my dad the first time he met him he might have to cut his leg off. (I'm not going to let that happen.)
Dad is fine. The surgeon may have personality issues but is a good doctor. I'm going to wait and talk to the wound clinic doctor when we see him a week from today. I am inclined to let the surgeon try one more time to open the artery, and if it can't be to then let matters be. I don't think anything will heal if dad has no circulation. The surgeon tried to tell me that my thinking was messed up, that no one could heal an infected bone, that it would need amputation...which is true, but normal people do not get an infected bone from wearing househoes that rub a small sore that they can't heal, either. Dad could not heal an amputation. It really would be his leg, and I don't want to butcher him. I need to talk to the wound clinic doctor though.
I am praying for you as I have been down that road. My father had a stroke which left him paralyzed on the right side and unable to speak for 13 yrs. The last year he developed a sore on his right ankle that would not heal. Like your father Dad's circulation was an issue. The Drs. tried so many things to help it improve with no success. The time finally came when he started getting gangreen that amputation was needed. They ended up having to remove his lower leg but to our surprise Dad handled it so very well. I hope you don't come to that but if you do it may be for the best. That older generation is a tough bunch and manage things better than we do.
Yes Mike, dad has very well controlled type 2 diabetes. The problem is that he also has three very plugged arteries, too. He also has vascular dementia and I am trying to figure out the least painful way for him to die. It seems to be a race here, and everybody in the medical community has an opinion.
Moiraine, so sorry you are going through this.
Your dad is lucky to have you as his ombudsman(woman). Patients, especially with dementia, NEED someone to look out for them.
Wishing you the strength to get through this with your dad in the best way possible....
I have decided to ask the surgeon to have another go at opening the blockage. He told me he might be talked into trying it again. It is dad's best chance. Dad has always wanted to live as long as he could. I had pretty much made up my mind when I talked to my brother. He told me that I had made the right decision. Dad had told the people in the dementia unit my mom had put him in before I got him that he wanted to live as long as possible. It has always been his motto. I just don't want him to suffer. I think if we can get some circulation going and get the toe off I can honor his wanting to live as long as possible with less suffering. If it does not work again...I won't try another time. It will be another bridge to cross.
I have worked in the CCL for over 20 years. I have helped open blocked vessels all over the body with many techniques and devices.
In your case, the details of how the blockage can be opened need to be understood. The doctors may have (and should have) explained what it takes to fix these things.
No matter where the blockage is, if it is done percutaneously, nothing can clear the blockage until a wire can be passed thru the channel (lumen) of the vessel.
If the wire can be passed thru the blockage, below the blockage, and into a normal (undiseased) area of the vessel, then a device can be passed along that wire and to the blockage.
A device could be a balloon, a stent, or a plaque reducing device. These devices have to be able to pass to and thru the blockage over the wire in order to open the blockage.
Even if the wire passes, there is no guarantee a device will pass. The device may be too bulky or the disease too much to get thru. If the device can get thru the blockage, this will open the lumen and allow bloodflow.
I would ask the doctor if they have used a device called The SilverHawk® Plaque Excision System ?
This is a device used to remove plaque that blocks arteries and interrupts blood flow. Unlike other methods of restoring bloodflow, the SilverHawk removes the obstruction – plaque build-up – instead of simply compressing it against the vessel wall.
I have used this device many many times. It is most useful in this very application. It may be that after this device clears the blockage there will also need to be a stent placed to help hold the vessel open.
Key to this process is the size of the blood vessel. We are talking about 1.5mm to 2.5 mm sized vessels---very small. Even with them being opened, the pressure (flow rate) that far down is low and the vessel may close up again.
Many times in these cases, there are what are called "collaterals", blood vessels that form around a blocked main vessel to try to get blood past.
Some doctors feel that if there are adequate collaterals to the area below the knee then there is no use spending time opening the main ones.
Amputation, while difficult to accept, many times it is inevitable in these cases. We try, sometimes for hours, to get these vessels open, only to hear a few months later that the limb just didn't heal.
Hyperbaric therapy may help, also.
Whatever happens, I hope your father finds relief.
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Moiraine, I totally agree with you that while some doctors have great skills, their "bedside" personality leave a lot to be desired.
And I totally agree with Phil&Liz....I can't state it better than that.
If the vessel can't be reopened, I strongly encourage you to consider hospice care. Someone does not have to be actively dying to be in hospice, but they do need a terminal condition and a doctor's diagnosis to qualify. I think in this case, hospice will be a great means of support for you and your Dad. They are not there just to make the patient comfortable during the dying process, they are there for the family as well, helping them through process as well. Hospice personnel are truly angels on earth.
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Lisa I agree with you about Hospice. As you know Dear Helen was under Hospice before she passed.
Moirane I understand your perdictament. Dementia is a uncureable desease. My Helen suffered with it for about 8 years. Hospice is for you and your Dad. I believe removing the toe would be your answer. I have sempathy for you and your Dad I know you will make the right decision.
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