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Elderly parents
Original poster

84yr old mum sent home with gangrene in her foot, need advice desperately.

54 replies

triplets · 06/06/2012 22:35

Its a long story but basically my mum is in a nursing home for respite care. She has dry gangrene in all her toes on her right foot and its now spreading underneath the foot, its so awful to look at as it must be kept open. She cannot walk but is supposed to be coming home with lots of nhs equipment to help. I just do not understand how we are suposed to cope, how can a foot like that just be left?? The team at the hospital said surgery was too risky, her aorta is blocked so they sent her home. Surely she can`t be left like this?

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Yeahthatsnotgonnahappen · 06/06/2012 22:46

Sorry to hear about your mom. Her surgeons will have weighed up the risks and benefits to operating. To put it bluntly, dry gangrene is unlikely to kill her but an operation very well might.

If she's in a nursing home they should be able to manage it fine. I know it's not very nice but this isn't an easy choice and this is probably the better option. At least she's in her own environment and comfortable rather than undergoing a very risky operation which may put her in a worse condition than she is in now.

Sorry again

edam · 06/06/2012 22:49

Have they arranged appropriate care in the community - visits from community nurses with skills in wound care, or podiatrists? I'd get onto her GP ASAP and find out what's been organised.

Northernlurker · 06/06/2012 22:53

Triplets, I'm sorry but if surgery is unsafe then leaving it open and trying to get it to heal as much as possible is all that can be done. It might be helpful to sit down with your mum and with her GP and ask them to discuss the discharge summary they have from the hospital? Then you can ask anything you need to about the prognosis for the foot.

Original poster
triplets · 06/06/2012 23:20

This will sound crazy but she hasn`t yet seen her new gp. Two days after she was admitted into hospital I moved her away from her gp, she has been very neglectful in caring for my mum, as has the local podiatry dept at the hospital. Two vascular surgeons were both horrified when we told them what had happened, told us we should put in a complaint. Now she is in respite the home use the local gp, I am not happy with this arrangement and if she cannot come home at least get her into a local home here.

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hiveofbees · 06/06/2012 23:23

What do you want to happen?

Original poster
triplets · 06/06/2012 23:40

What do I want? I just feel she would have been better off amputating her foot, if she didnt make it through the surgery like she said "I wont know anything about it" . Its very hard to get your head around the fact that she is just sitting in a chair 16 hours a day watching her foot rot in front of her eyes, knowing that it won`t stop there. Only being given painkillers. I really do not think its going to work her being able to come home, I cannot be there 24 hours a day with her. The best scenario would be to find her the best nursing home near me, where she could be under the care of our wonderful surgery.

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hiveofbees · 06/06/2012 23:52

It isn't just a risk of death during the operation. There is also a risk that the surgical wound doesn't heal, and then you are worse off then you were before.

What did the vascular surgeons advise, and did they explain their reasoning?

Original poster
triplets · 07/06/2012 00:32

just to take her home and try to carry on as normal.

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AdventuresWithVoles · 07/06/2012 00:35

Surgery to amputate her foot would be too risky.

My grandmother had something similar near the end; at least I remember a hole that went all the way thru her foot due to a form of gangrene. And terrible bedsores.

Sorry you're going thru this. :( Do you have a community nurse who will come in daily,to help with things like moving her around.

Northernlurker · 07/06/2012 07:34

This is very sad. I appreciate your mum's feelings and yours but the surgeons cannot undertake surgery where it is very likely that it will end the life of the patient. This sort of situation is very difficult for everybody Sad
Probably best to concentrate on getting her in a home near you then.

OneHandFlapping · 07/06/2012 07:49

Surely it's the patient's choice whether or not to have risky surgery? It's not for the doctors to decide whether or not your mum wants to live as she is. And in fact I'm surprised they have been so uncompromising.

My 89yo dad was offered a double knee replacement, despite poor circulation in his legs, and problems with thromboses. Risky or what? He turned it down, but it was his decision, not the doctors.

If your mum really wants the surgery she must say so.

Northernlurker · 07/06/2012 07:58

Onehand - it would be unethical to ask doctors to carry out an operation that they firmly believe will end the patient's life and that has no hope of a meaningful recovery. It isn't the role of a doctor to enable the ending of a life. It's a very upsetting and painful issue. Lots of patients would say they would prefer that outcome but much as you sympathise with that point of view it isn't consistent with the safe and proper practice of medicine.

gingeroots · 07/06/2012 09:26

triplets I am so sorry .
Did she go from own home to hospital to respite care and now going back to own home ?

As I wonder then who is responsible for ensuring adequate care and home adaptations in place before her return ?

Surely still the hospital ?
Have you spoken to Social Services - duty worker will put you on right track .

I don't know how much comfort but I have helped care for totally immobile person in own home ,she was given massive care package and lots of equipment .

The DNT should be able to care for her ,should be able to visit every day but would need input from podiatrist first .

So sorry again .

I've asked Fluffycloudland77 if she could pop over here and offer any advice as shes a podiatrist .

hiveofbees · 07/06/2012 20:07

To add to onehandflappings comment -It isnt just a question of surviving the operation. Where there is a problem with the vascular supply to the leg then it can mean that the wound wont heal, and it can mean progressive further amputation to try to get to a point where the wound will heal.

Original poster
triplets · 07/06/2012 22:59

Thank you all for your advice and concern. Quite a turn of events today. Firstly I called the local hospital as I knew the vascular nurse who had her admitted to hospital 4 weeks ago would be there. Wrong..........clinic cancelled as he is away for a two week holiday. So I spoke to his secretary to ask if any appointments had been made for mum with him as promised by the hospital..........no. Then at 11am I got a call from the social worker in charge of mums case, I told her what was happening, all of it. She was quite shocked and said we need to get Mum out of the home asap. I told her that some of the equipment she would need at home was already in place, she suggested two more items, she also said that Mum would be better off having her leg looked after by our local lovely district nurses She has set up a care package for 2 carers to come in three times a day, plus district nurse, plus physio. Phew......big relief. I wasnt going over to see her today as I am so behind here and my dh is still recovering from his lung surgery and the kids are at home. At 3pm one of my brothers phoned and said he was popping over to see her and would I like to go. I did, only to find when we got there that Mum was in bed, been there all day and had been in a lot of pain and they had had to call out their doctor to her. I went upstairs and there she was poor thing, she said she had had a terrible night with pain in that foot, she had pressed her buzzer at just gone 6am, no one came until gone 7am She said she had to have a doctor, she couldnt stand the pain in her foot anymore. The doctor arrived at 11am, just looked at her poor foot and said it looked as though it was infected, left a prescription for some stronger painkillers and a course of antibiotics. She was still waiting for them when we left at 6pm. We also asked about the swabs they took of that leg on the 28th May, well guess what? The lab cannot find them. So two new swabs were taken today, but you can see the infection.....I am worried sick about her. As soon as the rest of the equipment is in place she is coming home, its the most horrendous situation.

OP posts:
edam · 07/06/2012 23:08

Oh triplets, I'm sorry things are so hard for you and your poor Mother. That's appalling. I hope now you've got the SW on the case things are going to look up.

FayeGovan · 07/06/2012 23:28

oh triplets I'm so sorry for this awful situation

hope your mum gets the help she needs soon

ToothbrushThief · 07/06/2012 23:29

triplets this all sounds really hard for you. I hope you can get a team of medical carers in place to make sure your mum has continuity of care and full palliation of her condition

gingeroots · 08/06/2012 09:15

triplets - so sorry .
Sure you don't need to be told this but keep close tabs on infection ,she may need to go back into hospital for ab iv ,IYSWIM .

Is there any way that you can speak to the doctor who visited in the home - ask him if he can call and check your mum again say on Monday ?

And ( I'm a bore recommending this ) but I think this piece of equip is fab for less mobile at home .
Even know of someone who took it on caravan holiday !
IME people always seem to go straight to standing hoists ( if lucky ) or a hoist .
And they're big and remove even more independence .

It was offered ( too late sadly ) to lady I cared for .

Is a " non standard " piece of equip ,but cheaper than a hoist ,and I want people to know about it so that they can ask OT's about it .
( promise not connected to firm ! )
www.thiis.co.uk/new-products-cricket.aspx

Tianc · 08/06/2012 09:31

gingeroots, do you fancy posting about that clever platform-&-chair piece of equipment on MN's Wheeliedrome? It's a place to gather exactly this sort of info.

triplets so sorry you're all going through this. Three cheers for the social worker but as for the rest of them...Angry Hope your mum gets the care she needs ASAP.

gingeroots · 08/06/2012 09:48

Oh yes - I try and post about it as often as I can !

It's just so neat and simple and much less daunting for carers and person .

The old lady I knew was too disabled by the time she got hers ,it was really annoying seeing it sitting in her front room ( with it's gorgeous multi coloured shiny finish ,like a metallic paint finish on a car ) and knowing how perfect it would have been if she could have had 2 years earlier ! .

Original poster
triplets · 08/06/2012 17:57

Thank you Ginger, I will mention and show it to my brothers and the DN, your advice has been invaluable, no doubt I wil be back for more. So worried about the infection I rang our DN in my own surgery. She has her hands tied as Mum is under the care of the home, but is so concerned she is going to phone the home and enquire how Mum is and feed back to me. The hoist has been ordered, but nothing is going to happen until next week now. Just want to get her home. Thanks everyone for all your lovely messages. x

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gingeroots · 08/06/2012 18:58

triplets - re the cricket hoist ,it sounds as tho your mum will initially be using a hoist but it might be worth asking the OT for your local authority ( I think the DN or social worker could put you in touch ) if it would be appropriate for your mum to be considered for one instead of a hoist .

You need to talk about her retaining her upper body strength and independence .

Thinking about your mum and the infection .....could you or one of your brothers ask to speak to the doctor who saw her at the home ?
But hopefully the antibiotics will kick in soon .

Good luck ,let us know how things go .

gingeroots · 08/06/2012 20:15

triplets - when your mum goes back to her own home she will have a new GP will she ?
Can you talk to that GP about DN's coming in and arranging an assesment by a podiatrist ?
It's just that the podiatry thing can take ages ...

Is you mum going to be registered with your GP ? Wasn't sure .

Hope your DH is improving ,I can't even begin to imagine the amount of strain you're under .

Original poster
triplets · 09/06/2012 00:02

Ginger you are such a good find on here:) Mum is registered now at my surgery and is actually under the same gp as me. She hasnt met her yet because of the speed in which things have happened but Mum has met Lesley the senior DN in our practise. I know Lesley well as she came often to flush Harrys picc line out. I didnt go to see Mum today as dh had a hospital appt this mornig and my trio had opticians apt this pm.I phoned my brother this evening and he said Mum was back in her chair, no appetite and was very low. We had another bit of a blow today here. Dh phoned the Mac nurse to see if they had recd the histology report on the lung tumour he had removed 3 weeks ago. They had, not what we wanted to hear. They removed 25% of his lung away with the tumour to make sure thay had got it all, but the report shows that there are cancer cells in the tissue up to all margins. Meaning there are more than likey cells left in the remaining lung. The team up at Kings are reviewing the scans etc, we will get an appt to go back to the onc in two weeks time for their outcome. The most likely scenario is back onto chemo, a black thought. He also still has to have abdominal surgery to repair two hernias. So just abit more to worry about.

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