Post-in­ten­sive-care syn­drome now rec­og­nized

Cape Breton Post - - HEALTH/ADVICE - Keith Roach Dr. Roach re­grets that he is un­able to an­swer in­di­vid­ual letters, but will in­corpo rate them in the col­umn when­ever pos­si­ble. Read­ers may email ques­tions to ToYourGoodHealth@med.cor­nell.edu or re­quest an or­der form of avail­able health newslet

DEAR DR. ROACH: Two years ago, my wife (age 62, non­smoker, non­drinker) was hos­pi­tal­ized for a case of sep­ticemia. Her doc­tor at the time de­scribed her blood as "ba­si­cally toxic sludge." He said that she had gone into sep­tic shock and her prog­no­sis was poor. How­ever, af­ter a pe­riod in in­ten­sive care and be­ing flooded with an­tibi­otics, she was re­leased from the hos­pi­tal. She had some dif­fi­culty in mo­tor co­or­di­na­tion, mem­ory and such, but she is do­ing much bet­ter. She joined a weight-re­duc­tion pro­gram, has lost a lit­tle over 100 pounds and is cur­rently 145 pounds (she’s 5 feet, 6 inches tall). The one con­tin­u­ing area of con­cern is her mem­ory. She for­gets just about ev­ery­thing. Are there any known treat­ments, food sup­ple­ments, vi­ta­mins or any­thing else that we might look at to help im­prove her over­all men­tal func­tions? — C.H.

AN­SWER: It sounds like your wife has a con­di­tion called postin­ten­sive-care syn­drome. This syn­drome is just be­gin­ning to be rec­og­nized, and of­ten is not rec­og­nized or is at­trib­uted to some­thing else.

Af­ter a se­ri­ous ill­ness re­quir­ing a stay in the ICU, vari­able declines in cog­ni­tive func­tion oc­cur in at least 25 per­cent of peo­ple. The num­ber might be as high as 78 per­cent. Sep­sis, in par­tic­u­lar, seems to have a high risk for de­vel­op­ment of the cog­ni­tive ef­fects of PICS.

Psy­chi­atric ill­nesses such as anx­i­ety, de­pres­sion and post­trau­matic stress dis­or­der also are com­mon af­ter an ICU stay. Women are at higher risk than men, and again sep­sis seems to be par­tic­u­larly prone to caus­ing psy­chi­atric ill­ness.

Phys­i­cal is­sues also hap­pen post-ICU stay. Dif­fi­culty with mo­bil­ity (64 per­cent), chronic pain (73 per­cent) and the need for help with ac­tiv­i­ties of daily liv­ing (80 per­cent) are much more com­mon than pre­vi­ously rec­og­nized. These changes can have many causes, and sep­a­rat­ing out the ef­fects of the un­der­ly­ing ill­ness ver­sus the detri­men­tal ef­fects of the ICU stay is chal­leng­ing.

PICS can have a pow­er­ful ef­fect on fam­i­lies, with care­givers them­selves hav­ing in­creased risk for anx­i­ety, de­pres­sion and PTSD.

In your wife’s case, it seems like the ma­jor is­sue is cog­ni­tive im­pair­ment. In gen­eral, this is treated the same way that mild cog­ni­tive im­pair­ment of any cause is treated, and, un­for­tu­nately, very lit­tle has been proven to be ef­fec­tive. Medicines for Alzheimer’s dis­ease, such as donepezil (Ari­cept), have been stud­ied and were found to have lit­tle ben­e­fit, while car­ry­ing a sig­nif­i­cant risk of side ef­fects. Herbs, like ginkgo biloba, have been found to have no ben­e­fit. Phys­i­cal ex­er­cise has been help- ful in some stud­ies, and mem­ory-train­ing pro­grams have been shown in re­search stud­ies to im­prove func­tion.

DEAR DR. ROACH: I am con­sid­er­ing an­kle re­place­ment surgery, but ev­ery non­med­i­cal per­son I talk to acts sur­prised that it is even done. What is the suc­cess rate, and do you rec­om­mend it? — S.F.

AN­SWER: Many joints can be re­placed, not just the hip and knee, which most peo­ple are fa­mil­iar with. The shoul­der, wrist and even fin­ger joints can be re­placed, as well as the an­kle. Rheuma­toid arthri­tis is the in­di­ca­tion for which an­kle re­place­ment surgery has been stud­ied, and a 2004 study showed that with newer-type joints, about 90 per­cent were still suc­cess­ful af­ter six years.

How­ever, not a lot of these are done, so I can’t share any per­sonal ex­pe­ri­ence my pa­tients have had with an­kle re­place­ments. As a gen­eral rule, I would ad­vise cau­tion be­fore con­sid­er­ing a fairly dras­tic so­lu­tion. I wouldn’t rec­om­mend it un­less your symp­toms are pretty se­vere.

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