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Question:

From Magalia, California, USA:

My son-in-law's father has diabetes. He is 56. He broke his leg about a year ago. The hospital didn't pack the cast correctly and an ulcer developed. Then complications and he was sent home a couple of times from the hospital with incorrect antibiotics. His family is quite concerned that one of the doctors is presenting the idea of amputation of his leg now. Where could I get more information about this, pros and cons, when to consider it? Also, what consumer rights are available about the hospital mishandling the case?

Answer:

Many years ago when I was working in a children's hospital in London it was routine practise with every patient and every doctor for the social worker to make sure that the families really understood all that they had been told. I say this because when patients or family members are deeply stressed about the implications of an illness they often don't take in what is said and to be honest hurried doctors don't always take the time to make sure that they have been understood. I say all this because I think that it is possible that your family's problems may in large part be due to communication difficulties rather than to any professional negligence. I don't of course have any details as to how long your son-in-law's father has had diabetes or on his levels of blood sugar control over the years or any details of his bone injury. I also don't know if his present condition is causing major problems in home care and ability to work etc. What is certainly possible at his age, even probable, is that even before he broke his leg that there was evidence of vascular complications due to his diabetes.

Roughly speaking these are of two forms, microvascular which primarily affects the retina at the back of the eye and the kidney and macrovascular which involves large blood vessels especially in the lower limbs. If such changes were already quite advanced it could explain the ulceration and the failure of the antibiotics. I suspect too that the talk of amputation is either because here has been poor union of the fracture or because there is evidence of inadequate circulation in the foot and is a step intended to improve your son-in-law's father's quality of life by making him more mobile.

In these circumstances the first step is for you son-in-law and his father to talk over their problems with the medical social worker and to enlist her help in arranging a conference with both the orthopedic and diabetes doctors so as to get a thorough understanding of both the long and short term implications of the leg injury and the diabetes.

I dont think that further library research will help you; but you might nonetheless want to explore PubMed. I very much hope that you will not be tempted into litigation.

DOB

Original posting 14 Mar 1999
Posted to Complications

  
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Last Updated: Tuesday April 06, 2010 15:09:02
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