Post-intensive-care syndrome now recognized
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.