A diabetes-related leg amputation is coming up soon for my LO. She is non-ambulatory, so rehabilitation and a prosthesis are not going to be attempted. The amputation is being done primarily to avoid further complications/infections and to give her as much comfort as possible with whatever time she still has.
She's been through a lot recently, and her mentation wasn't great to begin with. I am not at all clear on what her awareness level is (i.e. one minute she can't remember her son's name, but the next minute she remembers accurate details about the person who drives the facility's van.)
One family member feels this lady "deserves" a lengthy preop discussion and feels it will prepare her for the reality of her leg being gone after the surgery. I do not feel she will understand or remember a preop conversation and therefore it would be unhelpful and very stressful. I was at a recent appointment with this lady at which the amputation was discussed and she had no reaction at all. And it wasn't like she was pouty and ignoring us, it was like she was mentally "checked out" and I think that's the situation much of the time in terms of explaining things to her.
The elephant in the room is the reality that anesthesia will make her mentation even worse. And we don't know how much worse or in what specific way.
I am not clear how much to try explaining to her. However, I cannot imagine waking up from surgery and realizing my leg was gone. Not knowing her mentation or what she understands/remembers I don't know how to approach this. I fear she will continuously rediscover that her leg is missing and will constantly relive that over and over.
So I'm hoping someone on the forum has seen this situation - dementia with moments of apparent clarity.... when a major surgery is looming. It's really two questions: What do we tell her beforehand? And, how do we support her mental state when she realizes her leg is gone and then possibly cannot remember the leg is gone?
What has been the advanced directive situation?
Has palliative care options and consult been done?
Is it time for hospice.
With a diabetic MANY amputations end up non healing and open to infection and sepsis just as she is already prone to. It is often an inch at a time surgery being done. There is the problem of phantom pain (when the limb removed hurts).
I would almost certainly not do this surgery for a loved one who was no competent to approve and understand it and the rates of failure in it. There may be gangrene involved. If so that is also not a good way to go.
I would consider, as I said, consults for all options including palliative and Hospice, and then try to come to the best solution I could were I the POA.
If there is a way to talk to her POA about not amputating, I'd try my best. The loss of a limb is going to terrify your loved one, especially if she's checked out. I'm not sure why she doesn't qualify for hospice...you might consider getting a second opinion. Best of luck.
My GF had her leg amputated up to her knee. Juvenile diabetic. She refused Rehab so they sent her home. She was in excruciating pain. Ended up needing to go to a specialist. Her stump healed but she did have a sore that took a long time to heal. Then there is phantom pain in the part of the leg thats not there. And the longer she is under, the worse her Dementia will be and the time for the anesthesia to get out of her body. And the shock to the system. I so would not put someone with Dementia thru this. I would call in hospice and let nature take it course.