Late effects

Many former sepsis patients still complain about impairments years after the disease. Possible late effects of sepsis include nerve and muscle damage, pain, cognitive impairment, reduced resilience and psychological disorders.

Cognitive impairments

During sepsis, inflammatory processes spread throughout the body. All organs may get affected. The brain can also be affected. As an indicator of a particularly severe course, the duration of treatment in the intensive care unit is a proven risk factor for the occurrence of brain damage. Not much is known yet about the causes. Also, these long-term consequences do not necessarily appear immediately and are therefore often no longer associated with sepsis.

If the following symptoms are present, brain damage could have occurred in the course of sepsis:

• Reduction in resilience (physical or mental)
• Poor concentration
• Slowing of the reaction capacity
• Attention problems
• Decreased mental receptivity
• Impaired memory capacity
• Reduced mental flexibility and ability to adapt to new situations

Such cognitive impairments are often accompanied by psychological disorders such as anxiety and depression. They are a consequence of the experiences during the illness as well as the long-term effects of sepsis on everyday life and social relationships. They can also be a further characteristic of the functional disorders of the brain.

These and the aforementioned cognitive impairments can reinforce each other in the sense of a vicious circle.

Cognitive disorders can also be the result of a mental disorder. Cognitive disorders may accompany you for the rest of your life. But there are ways to reduce the limitations, to compensate for them and to learn to live with them.

Do you have such complaints? Then you should seek neurological or neuropsychological treatment to be examined for cognitive disorders and to discuss further treatment options. Neuropsychological therapy is designed to reduce brain dysfunction and the associated limitations in mental performance, to promote adaptation and to improve your participation in social life again.

Within the framework of occupational therapy, you can take advantage of so-called brain performance training. Concentration and memory games such as riddles, puzzles or Sudoku can be just as helpful as various programmes for independent brain training that can be found on the Internet. Some health insurance companies offer numerous courses that are especially designed to help people cope with stress and promote relaxation.

Perhaps, the most important thing is: Stay active mentally, physically and socially, as best you can, even if you feel like withdrawing. Activity in everyday life is the most important training for your brain.

Would you like to get in touch with former sepsis patients who are also affected by neurocognitive impairments? Then contact Mr. Köhler or the office of DSH.

Psychological effects

About 55% of former sepsis patients develop symptoms of increased psychological distress in the first year after discharge from hospital. Similarly, many relatives who may have witnessed a person close to them being exposed to a life-threatening situation suffer from the psychological effects. Particularly depression, anxiety disorders and post-traumatic stress disorder (PTSD) are to be mentioned here. In some cases, the symptoms only appear in the long-term course - i.e. months, sometimes years later.

PTSD is a psychological reaction to an extremely stressful event, as a life-threatening illness certainly is. Every person reacts individually to stressful experiences. Sleep disturbances, nightmares, low moods, irritability, indifference or pronounced anxiety can be the result. Often the change in personality is met with incomprehension in the social environment, which in turn triggers frustration in those affected. The relationship with the partner can also be affected.

Studies also show that people who had increased symptoms of PTSD after sepsis also had more severe physical symptoms (fatigue, aching limbs, stomach and heart complaints) than patients who did not have increased PTSD symptom scores. Since the symptoms can take a chronic course if left untreated, PTSD should be treated through trauma-focused psychotherapy, if necessary with medication support through psychotropic drugs. Make absolutely sure that the psychotherapist treating you has the appropriate qualifications and experience in trauma therapy.

Mental disorders can also be an indication of brain dysfunction. This should be clarified by a neurologist. Both patients and their relatives often want help to cope better with mental limitations. You can consult the following people:

• The general practitioner should always be the first contact person. He or she can clarify whether there are organic causes for the symptoms and refer them to doctors who can treat them further.
• After studying medicine, a psychiatrist has completed a specialist training course in which he/she has acquired knowledge of mental illnesses. Psychiatrists are allowed to prescribe medication.
• Psychological psychotherapists, after studying psychology, complete additional state-certified training. They focus on the psychological causes of symptoms. Their treatment is based on scientifically proven procedures; they do not use medication. Therapy is designed to help the patient deal with the causes of their mental illness and learn new ways of dealing with it. Psychotherapists can also be consulted without a referral from the general practitioner.

You can find psychotherapists in your area on the websites of the respective chambers of psychotherapists. Health insurance companies can also provide information about psychiatrists and psychotherapists. It makes sense to ask several psychotherapists, as there are often waiting times. In the first conversation, you should always clarify whether it is possible for the health insurance company to cover the costs.

In addition, psychotherapists offer the opportunity to introduce themselves in a psychotherapeutic consultation and to clarify whether treatment would make sense. Such a consultation usually takes place after an appointment has been made. It is intended to ensure direct access to psychotherapists and to bridge the long waiting times. In addition, appointment service centres of the associations of SHI-accredited physicians, which arrange appointments for consultation hours, should simplify the search for therapists.

In addition to these clinics, there are psychotherapeutic outpatient clinics. They are usually affiliated with universities, training institutes or hospitals.

If the step to psychotherapy is still difficult, psychosocial counselling centres are alternative points of contact. There are often local offers that can usually be found via their website, in the daily newspaper or in the telephone book (under "Counselling").

Sometimes it makes sense to seek support at short notice, for example if a long wait for an appointment is unavoidable. Self-help groups are also an option. Offers can be found online, for example via the National Contact and Information Centre for the suggestion and support of self-help groups.

Not only the sepsis patients themselves, but also their relatives can get in touch with people who have experienced similar things. The focus is on mutual support.

A call to the telephone counselling service takes even shorter. However, counselling there cannot replace therapy. The numbers 0800 1110111 and 0800 1110222 are free of charge and available around the clock. Counselling is anonymous and open to everyone.

Nerve and muscle damage

Sepsis can cause nerve and muscle damage, which manifests as paralysis, loss of sensation, muscle weakness, coordination problems, difficulty swallowing and pain. This is called critical illness polyneuropathy (CIP) or critical illness myopathy (CIM).

There are many causes, but they are not yet fully understood. For example, machine ventilation, lack of exercise, medication and artificial nutrition may cause the damage. Mild forms of the disease can disappear completely, while only a partial improvement can often be expected in more severe forms.

If you have symptoms and complaints that point to CIP or CIM, it is advisable to consult a neurologist. He or she will discuss further diagnosis and therapy with you, such as occupational and physiotherapies or pain management.

Amputations

In the course of sepsis, blood circulation is disturbed in the smallest blood vessels. In extreme cases, it is possible that, for example, a finger end limb dies. Amputation of the affected limb may become necessary. In order to cope with such a traumatic event and to deal with the resulting limitations, special physical and psychological treatment is necessary.

Discuss the further procedure with your attending physician as well as therapies and rehabilitation options tailored to your limitations. If you would like to get in touch with former sepsis patients who have also had an amputation, please contact Mr. Trumann or the DSH office.

Weight loss

Many patients lose weight during their stay in hospital - especially if they receive intensive care for a longer period of time. This often continues in the initial period after discharge from hospital.

Discuss a possible diet plan with your general practitioner. In addition to normal food intake, he or she may consider giving high-calorie sip feeds. If weight loss continues, other triggering factors need to be checked, such as dental problems or swallowing difficulties.

Pain

Chronic pain is one of the long-term consequences that some former sepsis patients suffer from. In the first place, a doctor should clarify whether other diseases are the cause of the complaints. Many large hospitals in Germany have a pain therapy department that specialises in treating chronic pain patients. In addition to the administration of painkillers, the therapy can include physiotherapeutic measures, learning relaxation techniques and psychosocial support.