Amputation now on schedule

[worriedinalabama]

My husband is slowly waking after being sedated for four weeks. He is in a long-term acute care facility. I am unable to see him because of the COVID restrictions, but did FaceTime yesterday. During the morning session, he acted very sleepy and was not really with it, but in the afternoon, he actually talked over his trache tube, and he still has the larger tube. I was so excited! It was the first time he had spoken to me since May 7. They are still weaning him from the ventilator, but after that, we still have a few more hurdles to cross. The doctors have said he will have to have all of the toes on this left foot amputated and his right leg amputated from mid-tibia down because too much tissue on his right foot has died -- it's about halfway. I was only told in the past week that this was probably caused by the Heparin Induced Thrombocytopenia, but the ICU at the last hospital did not do anything when his toes turned purple and black. When I asked about them, I was told, "Don't worry about it." Has anyone else experienced something similar? What was the outcome?

[Sepsur]

That’s awful, I’m sorry. I hope you get clarity in the coming week.

[NDFan65]

I’m so sorry. This is not the same, but I have a cousin who was in ICU with Covid the same time as my dad. My cousin had a below the knee amputation a few years ago due to uncontrolled diabetes. With rehab, he was able to walk with a Prosthesis. After he got Covid in April, he was on a vent for many weeks and got a Trach on May 21. He’s now in an acute rehab hospital with their main goal of having him to breathe on his own. Once he can do that, he will be transferred to a sub acute Rehab facility to regain his strength and relearn to walk with his prosthetic.

Thinking of both of you as your husband’ continues his recovery. 🙏🏻

[worriedinalabama in reply to NDFan65]

Thank you. That is encouraging. I am hoping my husband is making progress with his weaning.

[RockRunner]

I’m sorry to hear this. My husband will require both thumbs and index finger and tip of middle finger on right amputated although we actually have to wait for them to drop off and then be tidied up as this has the best chance of preserving most of the live tissue. It’s a side effect of the nova adrenalin that was required to keep him alive and nothing could have been done to stop it. His blood pressure fell so low that had masses of the drugs not been given his organs would have shut down. So the drug keeps the blood pressure high enough to pump oxygen to the viral organs, this draws it away from the extremities. He was on the maximum dose and they said they couldn’t give anymore and he was slipping away. However the day after went in to say goodbye his BP increased every so slightly and from then on he improved very very slowly over time and they could slowly reduce the amount of the drug. By that time the damage was done to his fingers. Once the tissue has died there isn’t anything that can be done. I have heard of others who will lose toes but they have been told they will drop off. It’s awful as it is impeding my husband’s rehab, he can’t do anything for himself without the use of his hands. However we are looking at it as the price for being alive. His kidneys also have what looks to be permanent damage. But once they drop off and any further amputation or plastic work is done and healed, he will adapt. I would say to cross that bridge when you come to it because we were told it often looks worse than it is. The vascular surgeons and possibly plastics will need to assess and they may want to also wait and see what happens to preserve as much as possible, he may not lose part of his leg. The priority right now is the weaning, there will be hurdles in the future but all you can do is take one day at a time. Looking ahead at this stage will seem overwhelming. You and he will get there and deal with whatever comes later. You have both done amazing so far xxx

[Rhyl1 Partner Moderator ICUsteps]

Heparin induced thrombocytopenia is an allergic reaction to heparin. The diagnosis is done by a combination of the clinical presentation of the patient plus laboratory confirmation of antibodies. This needs to be recorded in his medical notes and his GP informed. He shouldn’t receive heparin again in the future and a non-heparin anticoagulant used instead.

Really once his toes turned purple and black there was very little the doctors could have done except wait and see. But clear communication to you would have help you to understand what was happening.

There is a good downloadable plain English information sheet at:-

nhsbtdbe.blob.core.windows.....

[Taciab2020]

Yes. My brother in law was sedated due to sepsis shock. His blood pressure got so low that they needed to give him high doses sold adrenaline so he would come back to normal. He took a while to be himself again after waking up from sedation. It took a while for him to be able to move well. The medicine to raise the blood pressure affected his extremities and his toes (both feet) and his right hand thumb will need amputation. The whole situation is sad but remembering how much he overcome, and hearing from doctors he is miracle to be alive, we praise God for choosing to hear our prayers and to restore my brother in laws life.

Praying for your husband. The amazing God is with him and with you. Blessings.

[kelseyT]

Hi, I'm so sorry to hear about your husband's struggles, but am glad you got to talk to him and that thinks are starting to look up. I was on a ventilator for 4 days due to sepsis back in November 2019. Both the sepsis and medications I was on to try to raise my blood pressure (vasopressors), caused me to lose blood flow to my hands and feet. This was incredibly painful, so I hope they are keeping your husband's pain managed until his surgery. I had to have all of my toes amputated in December 2019. Thankfully, my fingers and hands regained blood flow in time to save them, and they are back to normal today. Although it was an added trauma on the long list that occurred during that dark time, I'm thankful to be alive, even without toes.

[Ruthxx]

Hi, something similar happened to me, was in induced coma for 4 weeks, some of the meds they gave me restricted blood flow to my feet resulting in gangrene. They thought I'd just lose my toes. Said they'd come off themselves and that was better for me, however I ended up having surgery to amputate both feet, half way down. I can walk with crutches but it's painful. Took a lot of rehabilitation and physio. When I was weaned off ventilator it took some time to get my head around what was real and what wasn't. Had some horrible nightmares, apparently it's common. Sending love xx