ER -- Losing Part of Yourself
When you've lost your house, your husband, the city you grew up in, how can you bear to lose anything else? That's the question a Katrina survivor must ask when she finds herself in the County General ER faced with amputation of two of her toes.
On last week's episode of ER -- Breach of Trust -- an African-American woman is brought in after falling down on the sidewalk. Her sugar is high and she has what appears to be a chronic infection at the base of one of her toes. An X-ray shows Osteomyelitis -- a bone infection -- in the bones of her second and third toes.
The woman has been taking antibiotics, but they aren't working. When Dr. Kerry Weaver tells her that the only way to stop the spread of infection is to amputate her toes, the woman refuses and leaves the ER.
WebMD's Dr. Brunilda Nazario says that this is right on target, "Osteomyelitis in people with diabetes is usually associated with heart disease or vascular insufficiency (blood vessels not functioning properly or delivering vital nutrients and oxygen to tissue and working as channels for blood flow to other areas of the body). It commonly occurs in the foot and ankle regions and antibiotics usually fail to cure the affected site. Poor blood flow to the area results in low oxygen to tissues which continue to die off leading to ulcerations of the skin, increased infection risk, and seeding of the underlying bone with bacteria."
Dr. Louise Chang concurs, "People with diabetes are at risk for foot infections. This is because they may have nerve problems related to the diabetes (diabetic neuropathy) which makes it difficult to feel that they have a sore or wound on their foot and then a small wound can become a more serious infection, i.e. reaching to the bone -- osteomyelitis or blood stream. Diabetics also have problems with wound healing so they can develop very bad wounds which might have started out as very small (a blister) but become more complicated."
Kerry follows the woman to the bus stop and finally garners her trust, convincing her to go back inside and consent to the surgery. When she gets up to walk back into the ER, she steps down and cries out in pain.
Dr. Nazario thinks this may have been a bit of added TV drama. "Pain in these patients is usually absent because of one of the most devasting complications of DM -- nerve damage or neuropathy," she says. "People with chronic infections may also have a resulting anemia -- the issue raised here is could her fall have been a complication of both neuropathy and the weakness/fatigue of anemia?"
As the plot thickens, we find out that this woman is from New Orleans and is a survivor of Hurricane Katrina. Her fear of loss seems to be complicated by the trauma she has already endured in her life. Because of her background and subsequent fear of the dark, Kerry tells her that she can stay awake during the surgery rather than have general anesthesia, much to the chagrin of the surgeon who will be doing the procedure.
Unfortunately, a complication during surgery means they end up having to put the woman under anyway, and they also discover that the infection has spread farther than they thought. They are going to have to amputate from below the knee.
In the end, we see a woman coming to grips with the loss of part of her leg. She explains how she and her husband refused to leave New Orleans and were finally trapped in their house by the rising water. They escaped by making a hole in the roof and climbing out and then slogging through the contaminated water to look for help. Sometime during all this she injured her foot, which is probably where the initial infection began.
She is angry. The ER writers and the actress did a good job of portraying the anger, sadness, and distrust that someone in her place would no doubt still be feeling, even more than a year after this tragedy. It also seems she is angry with herself.
Kerry suggests that her life and her experiences are a gift and she should use them to make sure that no one ever forgets what happened during Hurricane Katrina. I have to admit that I found the sentiment a little to canned after all this woman has been through. Her reactions seem to be right in line with someone experiencing post traumatic stress. And, after losing so much, would you want to lose a part of your body as well?
It was kind of nice to see one of the medical shows addressing the emotional and physical effects that disasters such as Hurricane Katrina can continue to cause for years after.
Related Topics:Resilience Lets Katrina Survivors Cope Laser Prevents Diabetes Amputation
Technorati Tags: ER, diabetes, Katrina, amputation
On last week's episode of ER -- Breach of Trust -- an African-American woman is brought in after falling down on the sidewalk. Her sugar is high and she has what appears to be a chronic infection at the base of one of her toes. An X-ray shows Osteomyelitis -- a bone infection -- in the bones of her second and third toes.
The woman has been taking antibiotics, but they aren't working. When Dr. Kerry Weaver tells her that the only way to stop the spread of infection is to amputate her toes, the woman refuses and leaves the ER.
WebMD's Dr. Brunilda Nazario says that this is right on target, "Osteomyelitis in people with diabetes is usually associated with heart disease or vascular insufficiency (blood vessels not functioning properly or delivering vital nutrients and oxygen to tissue and working as channels for blood flow to other areas of the body). It commonly occurs in the foot and ankle regions and antibiotics usually fail to cure the affected site. Poor blood flow to the area results in low oxygen to tissues which continue to die off leading to ulcerations of the skin, increased infection risk, and seeding of the underlying bone with bacteria."
Dr. Louise Chang concurs, "People with diabetes are at risk for foot infections. This is because they may have nerve problems related to the diabetes (diabetic neuropathy) which makes it difficult to feel that they have a sore or wound on their foot and then a small wound can become a more serious infection, i.e. reaching to the bone -- osteomyelitis or blood stream. Diabetics also have problems with wound healing so they can develop very bad wounds which might have started out as very small (a blister) but become more complicated."
Kerry follows the woman to the bus stop and finally garners her trust, convincing her to go back inside and consent to the surgery. When she gets up to walk back into the ER, she steps down and cries out in pain.
Dr. Nazario thinks this may have been a bit of added TV drama. "Pain in these patients is usually absent because of one of the most devasting complications of DM -- nerve damage or neuropathy," she says. "People with chronic infections may also have a resulting anemia -- the issue raised here is could her fall have been a complication of both neuropathy and the weakness/fatigue of anemia?"
As the plot thickens, we find out that this woman is from New Orleans and is a survivor of Hurricane Katrina. Her fear of loss seems to be complicated by the trauma she has already endured in her life. Because of her background and subsequent fear of the dark, Kerry tells her that she can stay awake during the surgery rather than have general anesthesia, much to the chagrin of the surgeon who will be doing the procedure.
Unfortunately, a complication during surgery means they end up having to put the woman under anyway, and they also discover that the infection has spread farther than they thought. They are going to have to amputate from below the knee.
In the end, we see a woman coming to grips with the loss of part of her leg. She explains how she and her husband refused to leave New Orleans and were finally trapped in their house by the rising water. They escaped by making a hole in the roof and climbing out and then slogging through the contaminated water to look for help. Sometime during all this she injured her foot, which is probably where the initial infection began.
She is angry. The ER writers and the actress did a good job of portraying the anger, sadness, and distrust that someone in her place would no doubt still be feeling, even more than a year after this tragedy. It also seems she is angry with herself.
Kerry suggests that her life and her experiences are a gift and she should use them to make sure that no one ever forgets what happened during Hurricane Katrina. I have to admit that I found the sentiment a little to canned after all this woman has been through. Her reactions seem to be right in line with someone experiencing post traumatic stress. And, after losing so much, would you want to lose a part of your body as well?
It was kind of nice to see one of the medical shows addressing the emotional and physical effects that disasters such as Hurricane Katrina can continue to cause for years after.
Related Topics:
Technorati Tags: ER, diabetes, Katrina, amputation
2 Comments:
Who made this diagnosis, a dermatologist, and internist, a neurologist or an oncologist?
Interested to know. I have similar symptoms.....sores on the ankles that won't heal. I am not a victim of Hurricn Katrina nor any other disaster. I simply cn't get rid of these sores.....have been diagnosed in the past with anemia. N1K@R3@aol.com
Are you by any chance diabetic, too? Although you don't have to be dx'd with diabetes, it can develop later on in many cases. So it really is something you should see your doctor for. Sooner than later, if possible. Start with your primary care doc and follow his recommendations, if you trust him. If not and you want to go to someone else, try finding a really good infectious disease specialist.
I didn't have a problem with my feet or ankles,(Thank the Lord!); but I did have problems with my fingers which ultimately was diagnosed as osteo- mylitis. Everything they say about it is true. It's very hard to get rid of!
I first lost the feeling in my ring and little fingers which then developed into the tip of my finger from the first joint to the tip turning black. It looked like raw meat with a black ring around the first knuckle and where new skin was trying to grow back. My internist immediately sent me to an infectious diseaes doctor who had me in the hospital later that day and on Vancomycin, a pretty strong antibiotic given by IV. Ten Months later, the fingers weren't looking so good again and I was running fevers to go along with everything else. So, he had me back in the hospital again for 30 hyperbaric oxygen treat-ments, an approved treat-ment for the osteomylitis I was discharged 6 weeks later when they had decided that they had done all they could with the HBO treatmenmts.
"We think we've done all we can with the HBO treat-ments and the fingers are looking MUCH better, so hopefully we've contained the infection for now. Time will tell if we got it all and if not, we'll most likely have to go ahead and amputate. But don't worry about it for now, we'll face that bridge when or if we get to it.
Well, It's been 4 months since that day and it sure looks to me like it's back again. Guess I'll be calling for a doctor's appointment first thing Monday morning. So.....
Please say a small prayer for me or wish me luck as I am not quite ready to face more weeks of being homebound while doing the IV antibiotics, or worse yet, amputation of 2 or more fingers. I wonder if an amputation is really the worst thing to do.
Sandy aka ButrflyWolf
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