Cellulitis of the hand-is it serious?

Parent Cafe
1

<p>I’m going to describe the events of yesterday, because I feel there is a piece missing.</p>

<p>My 86 year old mother’s family physician called me yesterday morning, while my mother was still in the office, to ask if I could take her to an orthopedic surgeon because she needed hand surgery for a diagnosis of a) cellulitis of the hand, and b) rupture of the tendon of the thumb. The nurse sounded the alarm bells and stressed I do this ASAP.</p>

<p>I called the surgeon’s office, and as soon as I mentioned cellulitis, they transferred me to a nurse (I heard urgency in her voice). The nurse scheduled an appointment for next week, but called back 5 minutes later to say that the doctor wanted to see her right away. (Third incidence of urgency.)</p>

<p>The PA working with the surgeon examined my mother first, and told her the ruptured tendon is something that has developed over time, and she didn’t need to have surgery if she felt she didn’t need to regain the use of her thumb. (She has partial use of it, and in fact never noticed that she can not extend it fully.)</p>

<p>But when the surgeon came in, he took x-rays, which showed bone spurs on her joint, and told her she needed surgery.</p>

<p>Surgery is scheduled for Tuesday, but my mother wants to cancel it. I’m confused, because initially alarm bells were ringing, but, as I understand it, the surgery is only to help her regain the use of her thumb. No mention was made of the cellulitis, which based on the reaction of the first person I spoke with at the surgeon’s office, I inferred was the more serious. She is on antibiotics for this.</p>

<p>For those of you with experience in this, or a medical background, am I correct in thinking that this surgery sounds like elective surgery?</p>

<p>Am I correct in assuming this surgery does not address the cellulitis?</p>

<p>If it were your mother, would you encourage her to go through with the surgery?</p>

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<p>Antibiotics should clear up the cellulitis. But when my 88-year-old dad had cellulitis in his middle finger, he was hospitalized and put on IV antibiotics for a week.</p>

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<p>Is she on antibiotics? Did they clean and cover the wound? Does she have an elevated temp., increased confusion, shortness of breath? Did they mention an appointment with an infectious disease specialist? Perhaps a call to her primary care doctor to relate what the orthopedic plan is might be helpful. Is the surgery scheduled as “one day”? Do you have lab work, EKG and Chest X-Ray scheduled. What are any pre-existing medical conditions, what type of anesthesia will they be using? Are you able to have her spend the night with you or for you to be with her in her home 24hours post-op? The bone spurs can cause more tendon tears and inflamation. If she has some mobility and can tolerate the pain, I would think that the cellulitis would be the priority. On a personal note, I have seen elderly family members respond better under the care of an infectious disease physician. Best of luck to you and to your mom.</p>

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<p>Also, you may want to visit this wonderful thread:
<a href=“Parents caring for the parent support thread (Part 1) - Parent Cafe - College Confidential Forums”>http://talk.collegeconfidential.com/parent-cafe/1385049-parents-caring-for-the-parent-support-thread.html&lt;/a&gt;&lt;/p&gt;

<p>Lots of been there/done that and support.</p>

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<p>Did they put her on antibiotics for the cellulitis? A lot depends on how quickly the caught the cellulitis and got her on antibiotics; you certainly don’t want it to become septic, especially given her age.</p>

<p>Not trying to scare you, but I developed an abscess in my abdomen seven weeks post-hysterectomy, two weeks ago. The abscess was really not painful at all. But I became septic very quick, and was a very, very sick person for several days - spent five days in the hospital with a drain in where the abscess was, and lots of IV antibiotics. Then was sent home with a PICC line to infuse my own antibiotics for two weeks You really, really need to be more worried about the cellulitis, again, especially given her age. I can see a scenario that, if they put her on a good strong antibiotic that would hold her over until Tuesday when they can really get in and clean everything out. And again, not to scare you, but mine came on very, very quickly - within four hours I went from fine, to just about wanting to die I was so sick. Every doctor I’ve seen since then (I had many while in the hospital, including an infectious disease doctor) has told me that if my fever were to go back up to over 101°, just go straight to the ER. So keep an eye on any temperature. It just really sucks when stuff like this happens over a holiday weekend, because you know the continuity of care is not the same as it is when it’s during a regular work week. </p>

<p>I actually ran a fever again last night of 100.2°. Called my home health nurse, who called my infectious disease doctor, and he had them come out and draw some blood this morning for running some labs. But again, was told to use acetaminophen, and go to the ER if the temp goes above 101°. I really, really hope someone put her on antibiotics, and a good strong one.</p>

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<p>@teriwitt, do you think they will clean out the infection while they are in there? That’s what I’m hoping, but the surgeon never mentioned anything regarding the cellulitis when he discussed the surgery.</p>

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<p>Yes, she is on antibiotics. I thought I posted that in my first post, but apparently not prominent enough. No temperature, no more confusion than she usually has. I did notice some shortness of breath when we were driving in the car, which was of concern. But I don’t know if that is a new development related to this.</p>

<p>The surgery is outpatient, and she will receive in home care for the first 5 days after surgery. </p>

<p>She has no pre-existing medical conditions. The only medication she takes is vitamin D.</p>

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<p>Since the thumb isn’t an acute condition it seems to me ( a non professional), that they would want to get the cellulitis under control before they put her at risk for it spreading.</p>

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<p>I’m a nurse practitioner, don’t work with your mother’s age group but have seen lots of cellulitis. Where exactly is the infection (redness and pain)? Is it getting better? Surgery is not a treatment for cellulitis, and there’s nothing to clean out unless there’s an abscess. Sometimes hand infections are difficult to treat - if her infection isn’t improving she may need IV antibiotics. Otherwise, should be ok taking meds at home. If the surgery is just to improve mobility and she doesn’t feel she needs it, she should certainly refuse.</p>

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<p>Again, depending on how bad the cellulitis is, and how well the antibiotics work, there may not be too much more for them to clean out on Tuesday. That would be a great case scenario. Does she live alone? I wouldn’t be very comfortable with that, unless there is someone checking on her throughout the day (even if it’s a neighbor or phone call from you, etc.). When I ran my fever last night, they told me to set my alarm for every four hours to get up and check it. And again, my fever came on very fast the first time around (normal to 102.3° in a matter of a couple of hours). And due to her confusion, do you trust her to keep an eye on her temperature?</p>

<p>When I was in the hospital, I emailed a group of friends of mine (actually, from CC) and told them what was up. I told them at that point, I would welcome any good stories of people recovering from sepsis, and indeed, I got plenty. And most of them were from people your mom’s age, and older. So the odds are in her favor; she just has to keep an eye on things.</p>

<p>As an aside, the night I got very sick was a Friday night. I didn’t know what was going on - I thought it was too far after my surgery to be having surgical complications, and I’d had a cold the week before. I was thinking along the lines of possibly a bad sinus infection or pneumonia (although I didn’t have a sore throat). I didn’t know whether or not to call my internist or my gynecological oncologist (who did my surgery). So I actually ended up calling our Blue Cross/Blue Shield 24/7 nurse hotline around midnight. I ran everything past her, she asked me some questions, then I think probably plugged my answers into some sort of chart. It was she who then told me to get to the ER within three hours. No dallying about calling any doctors, just get to the ER; and if I didn’t have anyone to drive me, call an ambulance. This woman I spoke to was my angel that night; she was spot on; I would not hesitate to call them back again for anything. If anyone reading this (especially the OP) has access to a 24/7 nurse hotline through their insurance, and have questions about medical issues after regular doctor’s hours, I highly recommend reaching out to them. </p>

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<p>Thanks @seren50. It’s difficult to know if her infection is improving, because she doesn’t seem to be aware of the condition, which I chalk up to her dementia. In my observation, it looked like it improved the day after she saw the surgeon, but I don’t know what it looked like before that.</p>

<p>I just can’t get past how the alarm bells rang as soon as I mentioned cellulitis to the appointment scheduler at the surgeon’s office. She interrupted me and said she couldn’t talk to me and had to transfer me to a nurse. At that point, I had no idea what cellulitis was, but her reaction sure scared me into thinking it was life threatening.</p>

<p>But then the surgeon didn’t seem to be concerned about the cellulitis,and only addressed the ruptured tendon. If this is only about regaining the use of her thumb, why did they call back and insist she be seen immediately?</p>

<p>I’m so confused.</p>

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<p>While there was no need for panicky interruptions, hand cellulitis does need to treated right away, to avoid potential damage/disability to structures of the hand. If the person has a fever or looks sick, or the infection looks bad, it may require hospitalization for IV antibiotics. Probably your mother’s primary doctor could have treated it without the knee-jerk referral to the orthopedist, but he/she was in Cover My Butt mode. It sounds like there’s some major lack of communication going on with the surgeon. If your mom has dementia, are you the health care proxy? Can you talk to them directly and clarify what the surgery is treating and how the cellulitis is being followed up? BTW, you should be able to tell if the cellulitis is improving, or at least not worsening, just by looking at it. What exactly does it look like now?</p>

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<p>I’m a MD. The urgent referral for cellulitis was to have an expert evaluate the severity: risk of functional loss of fingers/hand or risk of spreading to the bone which is very hard to treat once it gets to the bone. Surgery can be performed to drain an abcess which results in much faster healing of infections so you should ask if surgery is for any improvement in cellulitis. Probably the orthopod saw the infection and there wasn’t anything “hand threatening” with it so the just focusing on the tendon or bone spur issue. So just ask the office.</p>

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<p>Not to scare you, but…yes, cellulitis can be very serious. A friend of a friend recently died from an infection that started as cellulitis in her hand. The woman who died was only 42 and was healthy before the infection began.</p>

<p>Again, this is just one story from an anonymous person on the internet, but infections are funny things (and not ha-ha funny, but strange funny.) IV antibiotics may be necessary if the infection doesn’t clear up soon. </p>

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<p>FlyMeToTheMoon, it sounds like you need to talk to the surgeon and find out what the surgery is for, and what will happen if your mom doesn’t have it. If it’s a matter of regaining some use of the thumb, and your mom is demented and doesn’t want the surgery, then you should think about whether it makes sense for her to have it.</p>

<p>The surgeon should have made this clear already, but surgeons are not always good at communication.</p>

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<p>One more vote for treating the most concerning issue first. I have a relative who is a 13 yr breast CA surviver. The one thing that lands her back in the hospital is cellulitis.</p>

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<p>I will be calling both the family physician and the surgeon for clarification. No one is in today, so thanks to all of you for offering your expertise. Yoho, that makes sense. In fact, it’s the only logical explanation for that piece of the puzzle that was missing.</p>

<p>For those of you who have asked, as far as I can tell, it appears that the swelling related to the cellulitis has improved significantly, but again I don’t know what it looked like at its worst But on Wednesday, I was alarmed at how swollen her hand was, and yesterday I didn’t notice any at all, although the nurse from her retirement residence said she could still see some swelling.</p>

<p>I don’t believe the surgeon has hours until Monday, but I’ll be on the phone first thing in the morning.</p>

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<p>My elderly FIL had cellulitis in his ankle and it got emergency treatment. </p>

<p>The thumb issue? I am no MD, but it doesn’t sound connected to the cellulitis at all. Double check, but be prepared to tell the surgeon “no thank” you if it is just for mobility of the thumb. It is your call after weighing all the considerations, but I don’t think I would operate on the hand of a woman that age with Alzheimer’s who isn’t complaining about her hand. </p>

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<p>Not a medical professional, but I had cellulitis. It is a skin infection that can occur anywhere on the body. It can spread quickly if it is not treated. I had cellulitis on my ankle. I was treated with IV antibiotics. Surgery might be required to debride (cutting out infected skin) the infected area so that it can can heal. Call the surgeon and ask lots of questions about the surgery and the antibiotic treatment. It is serious.</p>

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<p>I vote to keep her on the antibiotics (if primary doc agrees) and then make a decision on the risks of surgery at her age versus the loss of thumb function or the other risks laid out by ortho.</p>