Stage 4 Sacral ulcer with no surgical intervention... Prognosis

[ergvepeog]

Hi Everyone (and especially the nurse):

My ex husband has a stage 4 ulcer measuring about 4 inches vertically by 6 inches horizontally which is to the bone on
the sacrum. This is a BIG ulcer! He lives alone.
He is T11 complete Asia A since 2005. I used to be his full time care giver and left a couple years ago. I still come in
once a week to clean, organize his meds and supplies. He is 75 years old.
He did not regularly check his skin in that area and I happened to notice a large stage 1-2 ulcer about 2 months ago.
I suggested that he return to his wound care doctor which he did. He was instructed to stay out of his chair (which
he did not). He has wound care dressing people coming to the house every day per his wound care doctor.
He has been seeing her weekly and she has been debriding regularly. He was seen at the VA for a second opinion
recently and was told that the ulcer was to the bone. He was on a course of oral antibiotics about 3 weeks ago
(Augmentin) but is off of that. His wound care doctor told him that surgery and bed rest were the only options
for this. The VA told him the same thing and suggested bone shaving as well. Oh... and they recommend a colostomy
as well.
He refuses any surgical treatment.
My question is... What is the prognosis here... I know, but I just want to see what you guys say.

Thanks for any help and insight you can give me.

[Jim]

If he doesn't get this taken care of he is going to die.

[Rook98006]

Good that you got him to see the doctor. My understanding is that he won't be able to stay hydrated with a large open wound. More bed rest can lead to another ulser if not managed. And higher risk for more infection if it can't be kept clean. Prognosis is not good. Sorry.

[SCI-Nurse]

Rarely will a stage IV pressure ulcer heal without surgical intervention. It is also very likely that he has significant osteomyelitis which would need to be treated prior to any flap procedure, and may need a surgical debridement as well. Osteomyelitis is found in 90% of stage IV pressure ulcers.

While some people do live a long time with chronic untreated pressure ulcers, the chance of him succumbing to either sepsis and/or protein depletion are significant.

If he is eligible for treatment at a VA SCI Center, that would be the best option, as he can remain inpatient on the SCI unit for the usual 3-4 month stay required to do the debridement, IV antibiotics for treatment of the osteomyelitis, the flap surgery, the minimum 6 weeks of bedrest required post-op, and the seating program (at best another 3 weeks).

Of course, no one can force him to have surgery, or to stay off the wound now (no laying on his back, no sitting, etc.) and, yes, deep pressure ulcers usually due require a surgical diversion of the colon, which can usually be reversed after healing (although most find it so much better for their quality of life that they don't have it reversed).

I have seen a few people who refuse both preventive measures and treatment of a pressure ulcer like this, and for some, it actually appears they are participating in passive suicide. I hope he will accept some psychological counseling as well.

(KLD)

[ergvepeog]

Rarely will a stage IV pressure ulcer heal without surgical intervention. It is also very likely that he has significant osteomyelitis which would need to be treated prior to any flap procedure, and may need a surgical debridement as well. Osteomyelitis is found in 90% of stage IV pressure ulcers.

While some people do live a long time with chronic untreated pressure ulcers, the chance of him succumbing to either sepsis and/or protein depletion are significant.

If he is eligible for treatment at a VA SCI Center, that would be the best option, as he can remain inpatient on the SCI unit for the usual 3-4 month stay required to do the debridement, IV antibiotics for treatment of the osteomyelitis, the flap surgery, the minimum 6 weeks of bedrest required post-op, and the seating program (at best another 3 weeks).

Of course, no one can force him to have surgery, or to stay off the wound now (no laying on his back, no sitting, etc.) and, yes, deep pressure ulcers usually due require a surgical diversion of the colon, which can usually be reversed after healing (although most find it so much better for their quality of life that they don't have it reversed).

I have seen a few people who refuse both preventive measures and treatment of a pressure ulcer like this, and for some, it actually appears they are participating in passive suicide. I hope he will accept some psychological counseling as well.

(KLD)

Thanks so much for the input... he saw the wound care doc and the ulcer is progressing... the doc wants to do a colostomy first and then the flap... the ulcer is huge... I know he won?t stand a chance without it... he is extremely set In His ways and most likely will die from this... it?s heart breaking... I was married to him for the first 12 years post injury and then left... to save my health and life... I know that sounds selfish but it is what it is. I will pass this feedback long to him... he is very afraid that if he has the surgery that he will never be able to return home..😢

[ergvepeog]

Thanks everyone for your input... it’s heart breaking...

[ergvepeog]

My ex-husbnd died on 12-28-19

If he doesn't get this taken care of he is going to die.

I wanted to thank everyone for their input and kindness when I posted about Don?s stage4 pressure Ulcer on His sacrum. He went septic on 12-27...he had called me to the house and I spent the nite with him. The next day he had agreed to go into hospice. I and one of his good friends were at the house the afternoon on 12-28. I had gone to run a quick errand and returned to find Don dead from a self-inflicted gun shot wound to the brain. I discovered the body and it was horrible. He had told me earlier that day that he didn’t want to spend his life in bed and he was so weak he couldn?t transfer anymore. This was a man who was injured in May of 2005 and died on December 2019.
I was able to save Don in 2005 by performing CPR on him at the scene of his 30 ft fall from a tree and was unable to save him those many years later...I am heartbroken...
Thank you for allowing me to share...

[SCI-Nurse]

Oh no, ergvepeog, I am so sorry! Words cannot express the tragedy of this outcome, and your loss. From all the SCI-Nurses, you have our deepest condolences.

(KLD)

[Treeza04]

So sorry for this outcome - sending vibes for comfort

[Sit-N-Fly]

I'm sorry you had to go through this experience. The unfortunate reality for many of us that are aging with SCI is that our lives become increasingly about managing rapidly declining health and loss of independence. Throw in the possibility of life-threatening events such as Don experienced and it can become overwhelming. And certainly during the holiday season, these feelings can dominate your thoughts. Don made a choice that can sometimes seem like the only way out. His pain is over and I hope you have friends and family that can help you deal with yours.

[Domosoyo]

So sorry for your loss and best wishes for you as you recover from this tragedy.

[slow_runner]

A few words come to mind. Desperation, despair, courage, pain, anguish, love, loathing, exhaustion.
I can empathise but only imagine his journey and his view of his future.
Sometimes life is a shit sandwich and the taste does not get easier to accept.
I am sure that you understand his decision.
Have the best life you can ergvepeog and to others in similar circumstance.