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My mom is 86 yrs old & is diabetic. Her 2 toes on her left foot were infected to the bones in Dec 2015. She had her 2 toes amputated in Dec 2015, then another 3 toes amputated after a week. Her left foot is still full of pus so Dr. in Vanuatu had her operated each week. In total, she had had 5 operations since Dec 2015 till now. With the lack of professional & technical resources and total absence of laboratory for research & testing in Port-Vila hospital, would my mom be better off being amputated continuously OR stop further operations. She's had 5 operations already and suffers greatly. She's been given panadol to minimise her pain daily. Dr. recommends she returns home even though her foot is still full of pus & advises her wound be cleaned twice daily & bandages changed. She can't stand nor walk anymore with her age & does her toilet in bed. She wishes euthanesia but ending one's life is not allowed in Vanuatu.
If she refuses further operations, what will be the consequences to her, in terms of painfulness, life expectancy etc...? Will she be better off with further amputations given her age & condition or live the rest of her life with her current condition? Please note that the public hospital in Vanuatu has very limited facilities. Most doctors are volunteers from overseas. Her Dr. in charge is on holiday overseas so a local doctor did the last 4 amputations.

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Also being geographically challenged I too had to look at the map. Is there any possibility of Mom being taken to somewhere like Australia where there is good medical care?
Panadol (Tylenol in the US) is totally inadequate to control the pain associated with gangrene. She needs some kind of narcotic. Is it possible to obtain something like morphine?
Cutting another piece of foot or toe cut off is only going to prolong the agony. Mom needs an amputation further up the foot or leg where there is still a good blood supply. If that is done she might stand a chance of recovery. Her desire for euthanasia is very understandable and I will not comment either way.
Stopping all further surgery will give her a prolonged painful death from septicemia. If she was somewhere that had good hospice services it would be possible to keep her comfortable during the dying process. The same thing is likely to happen if the small surgeries continue especially if adequate antibiotics are not available. This kind of infection will also make it impossible to properly control her blood sugars.
So I see there are several options, the best of which is to get her to a modern mainland hospital. If you can not afford to do that contact charities on the country of your choice and see if there is help available. You could start with the Red Cross. The next is do nothing and care for her at home obtaining whatever pain meds you can. Continue with the small surgeries. Amputate up to good healthy tissue. The last one would be to consult local faith healers if you have some and see what they can do to at least ease the pain. This is something hard to comprehend in the West but totally understand and wish there was a way to help more.
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For anyone as geographically ignorant as me - Republic of Vanuatu (French: République de Vanuatu, Bislama: Ripablik blong Vanuatu), is a Pacific island nation located in the South Pacific Ocean.
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She needs to elevate her legs at a level higher than her heart.
I sleep in a recliner at night, and for a couple of hours several times during the day and evening. No, I don't have diabetes, but a foot specialist at a wound care center encouraged me to do this as I have poor circulation.
Even though the infected areas on my feet have healed now, I continue to elevate, hoping to prevent sores from becoming infected again.
I am 75 years old, living in California.
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As a retired nurse, she is in real trouble. Without proper medical care her suffering will continue. Continuing to cut away body parts is not the answer, and whoever has medical power of attorney needs to consider all options. Pus is really the body's way of clearing infection and does need to be cleaned daily to wipe away the dead tissue. Get some professional help if you can, but you are fighting an uphill battle. I don't know what else to suggest and will pray her suffering is not long.
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Osteomyelitis requires longer term IV antibiotics, and Tylenol would not be sufficient for this pain. They should at least try a little gabapentin and go up on that as she tolerates it - it might limit the need for narcotics. I do suspect the idea of trying to give her good BK amputations instead of painfully diddling with this could be a good one, but they need a better assessment of blood supply and other factors to decide. Being unable to walk does not necessarily make you unable to care for yourself either, if the home is accessible and the arms and the brain work reasonably well.
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Have they tried silver sulfadiazine (thermazene)? It's a topical used on burn victims. How about Tramadol for the pain; it relieves anxiety at the same time.
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Dr discharged her from public hospital & she's back home. My sister bought IXPRIM from French pharmacy to reduce her daily pain as Panadol not effective. She also managed to borrow a handicapped bed from Red Cross. Now we just pray & wait for her wound to recover after amputation.
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Fion I think the best has been done for your Mom. Once she recovers from the amputation as long as all the diseased tissue was removed she has a chance of recovery.
I am not familiar with IXPRIM but I think it is Tramadol which again is a wise move given the inevitable pain of the amputation. Again I also have no experience with Tramadol, personally or professionally but hear it is effective.
The important thing now is to keep Mom comfortable and prevent secondary infection of her stump. I envision her as a large lady but if possible get her out of bed and exercise her good limbs. If you can also borrow a wheelchair short periods outside or wheeling her to a cafe or stores may improve her depression. Try and keep the diabetes well controlled and feed her a healthy diet. I imagine on a tropical island you have plenty of fresh fruits and veg.
Home is actually the best place for her to be right now even though the family may not be trained caregivers they are the people she loves and trusts.
In our well insulated lives in the US we have no idea of the difficulties people face in remote corners of the world.
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All I can say is this is terrible and I am so, so sorry you both are going through this! I wish you all the best.
Peace, strength and love!
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Thank u very much for all your advice & support. Vanuatu's local supply of fruits & vegetables all depend on the weather. Last April, nearly 100% of trees & houses were devastated & destroyed following a category 5 cyclone, leaving most people out of water & electricity. Vanuatu has received lots of clothings & food donations from overseas but I'm afraid all donations are not being distributed equally given the location of 80 islands & problems reaching remote areas (local infrastructure totally destroyed) .Hotels have recently been back to business following repairs & renovations. Recent political instability due to corruption plus the current drought don't help much to put the country back to development path. Scarcity of local food only increased the price of imported food. A head of cabbage (imported from Australia)at the supermarket, costed US$7-10 when I visited my family last February, after the cyclone the price doubled. There are only a few supermarkets, 2 chemists, one private hospital owned by expatriates, so u can imagine the exorbitant price they charge for goods & services, more than triple the price in Australia. Minimum wage is approx. US$250 a month with no social welfare at all. Locals depend on their own tribe's herbal medicine when sick & if unlucky ended up being poisoned like my nephew who passed away very young. Expatriates who are seriously ill or need to undergo operation usually go back to their own country (Australia, NZ, France...) to seek medical service. My family members are Ni-Vanuatu so have no choice but to pay the high price.
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