Hi! I'm a concerned great-granddaughter. Granny had a blood clot in her leg which lead to her having gangrene. It was the middle toe, it seem like it has started to spread to the toe next to the big toe. However a granny having dementia it’s hard to tell if/when she’s in pain. I do notice that when she’s sleeping she’s putting her leg up (like a tent) more and more? Could this be a possible sign of pain? Also everybody wanted to amputate the dead toe except for granny’s main caregiver (my grandmother). Any suggestions on how to get her to want to amputate so it can stop spreading? I've tried to explain gangrene and how deadly it can be to her however it seems like all she care about is granny missing toes, any help or suggestions is greatly appreciated!
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.