If untreated, how long will it take gangrene to take over the body?

2 answers | Last updated: Oct 28, 2016
A fellow caregiver asked...

My loved one in Georgia who is a couple of months away from turning 80 was diagnosed with CHF (Congestive Heart Failure) some years ago, but however manged well. Just about a 2 years ago she had a week long hospital stay and was told she needed a pacemaker and or defibrillator which she declined not believing she needed it.

Her health was somewhat steady for about a year and she returned to the hospital about 11 months ago and had over a 30 day stay at which time they said her heart was really bad and some of her organs were failing and she needed to consider hospice all of her vitals were bad. She finally got out of the hospital and went to rehab for a month and sort of had a comeback and did well for about a month.

She started returning to the hospital on a weekly basis with major issues and constant swelling. After about 2 months it was discovered that her kidneys were failing and again hospice was suggested and again she declined it. At this time it was suggested by a nephrologist that she go on dialysis, which was against what her cardiologist thought she should do.

She has been on dialysis for about 4 months now and hates every bit of it and even refused to go for about 10 days because she feels that it is not doing any good. It wears her out and she states starting dialysis was the worse decision she has ever made in her lifetime.

Recently about 3 weeks ago she returned to the hospital for severe pain in her feet and has now been diagnosed with no blood circulation in her foot and gangrene has set up in her toes. The doctor initially suggested amputation just below the knee and for the record she has not been truly mobile or really walked in about 5 months. However, now he says that basically there is nothing to be done because she is very frail and sits in a wheelchair or in bed all the time and has to be assisted 100% of the time with everything she does other than eat.

She has been referred to hospice over and over again and none of the doctors see long life for her and really her quality of life is not good. However, because she has overcome the odds so many times this year she seems to pay no attention to what they are saying. My question is if nothing can be done for the gangrene is it really worth going to dialysis and how long is it before the gangrene truly takes completely over her body?

Expert Answers

Jennifer Serafin, N.P. is a registered nurse and geriatric nurse practitioner at the Jewish Homes for the Aged in San Francisco.

Reading through your letter, it sounds like your loved one has had a tough road over the past several months. In my 15 years of experience as a nurse, I see many people end up in this kind of situation as they near the end of their life. Many chronic health problems start to take their toll on a person, like your loved one. They may get through each crisis (hospitalization), but each time the come home they are a little weaker, a little less able to care for themselves. Now, she is in a situation where she cannot take care of herself at all. Her quality of life is poor, and she has been in the hospital, which can be exhausting and scary, far too many times.

Now, on top of her CHF and kidney failure, she has gangrene. You do not say what kind of gangrene she has (there are 3 kinds: dry, wet, and gas). I am going to assume it is dry gangrene because her circulation is poor. Since she will not have surgery, she will eventually get a fatal infection in her legs that will end her life. I am sure her doctors have told her this, but I think that she is making a choice now to stop many of these invasive medical treatments. I think that she is reaching a point where she has had enough, and that is OK. I do understand her hesitation with dialysis, as it is hard for many people to do, and I can really understand why many people choose not to do at all, or to stop it. It really impacts quality of life, and it can really make you feel tired on the days it gets done. Regarding the offer of surgical amputation of her legs, with her heart problems, the chances of her surviving a leg amputation are slim at best. She has reached the point in her life where the options she has will not really extend her life much more.

You ask how long she can survive. In reality, she probably has months to live, and if she does not go back to dialysis, her prognosis may even be less than that. I would suggest she consider hospice now, as it seems more in line with her wishes. I know that many people have this idea that hospice means that you are giving up, but this is not the case. Hospice means that the focus of someone's care has changed from trying to cure medical problems at all costs to taking care of her problems in a way that makes her comfortable.

I personally know that it is hard and truly painful to let someone you love go. But, it is her life, and her choice to make. The best thing that you can do is to be supportive of her decisions, and enjoy her for the time you have left together. I wish you luck.

Community Answers

A fellow caregiver answered...

I am truly sorry that you and your loved one are going through this. I am a nurse and I love it...I treat my patients as if they were my family and I care about them very much. I have also personally been in your place with loved ones. My opinion is to respect your loved ones decision, whatever it may be. I know it can be hard to lose someone, and know that you have not done everything you wanted with her. That will never change. We will never be done loving our loved ones, but unfortunately there comes a time when we have to respect their wishes and show them that we love them so much that we will do so. She may not have much left, but she deserves to keep her dignity, and the thought that her loved ones were there and loved her so much that they were willing to give her up to save her from pain. I am truly sorry for the situation and pain you are all going through. I hate to watch my patients and their families ache. I hope you find peace and comfort.