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Discussion

What to do in this situation?

I had a patient today, who had a small ulcer underneath her fifth digit. She's diabetic and has had her right leg amputated when she was in her 20's (also from an ulcer). She had made the decision to get her leg amputated even when the Dr. insisted that she should try treating the ulcer, because she didn't want to keep coming back for the same problem.

Now, that ulcer that she has on her foot is also giving her osteomyelitis. This patient tells me she wants this leg amputated instead of going through the 6 weeks treatment for osteomyelitis. Her reasoning is: because I'm a diabetic and have neuropathy, the problem will always come back so I need get above the problem before it starts.

What do you do in this situation? Would you try to talk the patient out of this decision? When she had her right leg was amputated before, she said she wished that the Dr. had listen to her and gave her what she wanted instead of trying to treat the ulcer.

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Educate her, giving her options. The ultimate decision is between her and her doctor. She knows what an amputation encounters, knows what to expect, and is willing/wanting to amputate the other. Maybe she is willfully noncompliant at home with treatment and knows that it will only get worse. I dont know. Depression may be culprit.

Educate her, giving her options. The ultimate decision is between her and her doctor. She knows what an amputation encounters, knows what to expect, and is willing/wanting to amputate the other. Maybe she is willfully noncompliant at home with treatment and knows that it will only get worse. I dont know. Depression may be culprit.

I was thinking the same thing.

Educate your patient as best you can.

Many of the patients I have dealt with in Rehab have the experience of going a piece at a time so to speak. They did everything to save their legs, often times requiring multiple treatements and surgeries. A part of me understands this concept of fear that they have of history repeating itself.

Ask your patient what led up to her former amputation if you can get her to talk about it. Depression yes ,that certainly can be underlying. Fear, distrust that any outcome will not bring about desired outcomes.

Ultimately she and her physcian will come to terms with her decision. Doctors also have the choice to say. No, I will not amputate. Then the patient will need to find a doctor who do as she requests or not. While the patient has rights, so do doctors.

Also bear in mind some patients do not make their own decisons. They helplessly want to have others make the decision for them. This type of patient will only end up blaming others for outcome no matter what it might be.

She sounds like she is educated and completely aware of what she wants.

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