Life After Amputation

If you or a family member has recently undergone an amputation, you are aware of the life altering impact and changes that followed the surgery.

In the United States today there are about 2 million amputees living. Some lost limbs due to trauma. Some lost limbs due to disease. Some were born with limbs missing or so deformed that later required amputation. Roughly 185,000 people in the US will undergo an amputation this year. There are another 28 million people who are at risk of amputation. Most of those at risk are due to peripheral vascular disease and the complications of smoking.

I have always had a strong bond with the patients I have amputated. Amputee care is a two-way commitment. They are trusting me and I am helping them with the common goal of recovering independent living and self-confidence. Most amputees are grateful in the long run. In the short term it is a huge post-operative adjustment they and their family will have to overcome.

Common questions amputees have include the following:

• How will I complete common tasks?
• How will I care for myself?
• Will I be independent for my living and occupation?
• Will a prosthesis help me recover function?
• Will I have pain after the amputation healings?
• How different will my life be after amputation?

Emotional health and wellbeing

Your emotional health and mental well-being is as equally as important as your physical health. If you are having trouble coping with your emotions there are a number of areas of support that you can tap into:

• Get involved with a Peer Support Program. Being with others who share a similar experience can
  help to reduce feelings of isolation. Peer volunteers understand how you are feeling and can help you to adjust to changes in your day-to-day life. Peer amputee counselors can be found through the Amputee Coalition.
• Join a local support group. Amputee support groups provide a friendly and comfortable environment to share experiences with one- another.
• If you don’t wish to meet with a peer face to face, take part in an online discussion group. Online groups can provide connections to the wider community.
• Seek professional help. If you are experiencing depression, anxiety, anger, denial or grief following your amputation it is important to talk to a member of your healthcare team or your local doctor. You may like to speak to a trained counsellor to help you deal with your emotions. Your doctor can assist you with a care plan or refer you to a professional.

Peer support is an important part of the recovery and rehabilitation process. Early on in your journey to recovery you may experience uncertainty, have doubts and questions. Peer volunteers can help to ease the burden and provide support along the way. Receiving a visit from a Peer can be a rewarding experience and a wonderful way to gain insight to your new situation. Peer Support Volunteers are amputees like you; they are people who have experienced and lived with limb loss for a number of years. They have successfully adapted to their amputation, re- engaged with their community, and live independently.

Building a network of peers will enable you to share your own very personal experiences with people who understand. Peer networks can provide practical and emotional support in a group setting which will enable you to be listened to and heard. It may help you to develop confidence and feel more secure about your situation. Peer networks can be wonderful sources of information; they can give you tips, share hard earned knowledge and help to guide you to services and activities in your own community.

A Peer may be able to answer some of the many questions you may have about day to day activities; this may include using a prosthesis, using a wheelchair, driving a modified car, sport/s and community activities, along with addressing concerns of a personal and private nature.

Who is involved in Amputee care?

The amputee rehabilitation and recovery process is different for everyone, and can vary between facilities, states and territories. There may be a number of different healthcare team members involved in your care. Your healthcare team will work with you to help you to regain your independence and increase your confidence and help you to develop and achieve your goals. It is important to have recovery goals.

You should discuss your goals with your healthcare team and work with your team to develop a plan for
your recovery.

The healthcare team who may be involved in your care can include:

Orthopedic Surgeon– A physician with specialized training in musculoskeletal health care who routinely preforms amputation. Usually the Orthopedic Surgeon is captain of the ship until the wounds are healed, then care is handed off to a physical medicine specialist.

Physical Medicine and Rehabilitation Specialist (doctor) – oversees to ensure that your health and medical needs are being met. Your doctor together with your team will assess if you are fit and able to use a mechanical/assistive device, such as a prosthesis.

Occupational Therapist – helps you to adjust to day to day activities, like personal care, domestic tasks such as: meal preparation, accessing your place of residence, education or work readiness. If you are an upper limb amputee the Occupational Therapist will assist you with the functional training of your prosthesis.

Physical Therapist – will design an exercise program tailored to your needs. They will assist you to regain your balance, flexibility, strength and stamina. They will help you to use mobility aids such as: wheelchairs, walking frames, crutches and other assistive devices suitable for you. If you are a lower limb amputee, they will assist you to use a prosthesis.

Prosthetist – will look after the design, manufacture, supply and fit of the prosthesis. Together, you will discuss and decide on the prosthetic components to suit your needs and lifestyle. They will also teach you how to ‘donn and doff’ (put on and take off) your prosthesis and start your prosthetic training.

Social Worker – will provide confidential counselling assistance for you and your family. They can assist you with emotional support. Social workers will provide assistance with financial matters, transport, and your accommodation requirements.

Nursing team – assist you with medications, personal hygiene like bathing and dressing and any wound care and diabetic management that is required. They will liaise with your healthcare team about your specific needs or any referrals you may require.

YOU – The most important member of your recovery team is YOU. From the onset, you will be encouraged to play an active role in your recovery and care.

Depending on the reason for your amputation, other healthcare staff involved in your care may include:

Diabetic educator
Dietician
Exercise physiologist
Pastoral care worker/Spiritual Support from Clergy
Podiatrist
Psychologist (clinical or neuropsychologist) Sexual health counsellor

Caring for your residual Limb

Use a mirror to inspect the back side of your residual limb at least once a week or if you are having pain.
Check for stump/residual limb skin issues as you remove the socket style prosthesis
Check for skin breaks, ulcers or callus formation, if present the pressure points need to be adjusted.
A prosthetic limb should not be painful to wear or use.
If you find a red or irritated area when taking off the socket, take a picture and shoe your prosthetist.

There are a number of things that you should think about:

• Skin hygiene is very important: you should wash, clean and dry your residual limb (stump) daily, when bathing or having a shower as part of your regular personal hygiene routine.
• Stump socks and prosthetic liners should be cleaned and changed daily with a gentle fragrant-free anti-bacterial soap and rinsed well. More often if you sweat heavily during warmer months.
• Always dry your socks and liners properly.
• Stop wearing your prosthesis if you have any pain or discomfort.
• Wear safe and comfortable shoes.
• Hair removal : Amputees regularly ask about shaving or waxing their stump. Your healthcare
  team will discourage you from doing this. If you do decide to wax or shave your stump and the
  hair follicle becomes infected, you may be unable to wear your prosthesis until the infection
  clears. Seek advice and a second opinion if you are worried or concerned. Many amputees prefer
  laser hair removal to address recurrent follicle issues.

Prosthetics come in many shapes and sizes. You, your prosthetist, physiotherapist and your doctor will work with you to choose the best and safest prosthesis for you. This will depend on such things as:

• Your general level of mobility
• The condition of your residual limb (stump)
• Your weight
• Types of activities you do
• Your ability to look after yourself and manage your healthcare
• How comfortable you are with new ideas
• Any other health issues

A prosthesis for an elderly person who is only going to walk indoors will be very different to a prosthesis for someone who works all day in a manual job.

Prosthetic components have weight limits and recommendations based on mobility. Underestimating weight or activity levels could result in a prosthesis that is not strong enough to let you be active safely and this can be dangerous. However, overestimating weight or activity could result in you wearing a prosthesis that is heavier than it needs to be. To achieve the best outcome, you need to be honest in discussions with your doctor and prosthetist.

The help of a family member or career can sometimes be critical in deciding on the type of prosthesis that will best suit you. For example, as people age and/or other problems occur, some types of prostheses may be hard to put on properly. If you put on (donn) your prosthesis in the wrong way it can cause problems and be unsafe and uncomfortable, your doctor or prosthetist may suggest a simpler prosthetic system in order to keep you mobile and functioning. There are many other examples of how these factors can influence what is best for you. It is not always easy. Sometimes a certain type of prosthesis looks like a great choice, but problems may occur.

If you are a lower limb amputee sometimes prostheses, or the components of a prosthesis, are referred to by their ‘K’ classification. This is simply a measure of activity, for example:

• K1, Suitable for use on level surfaces at steady speeds. That is someone who only walks indoors
  and short distances outdoors for example to the car.
• K2, Suitable for outdoor use but at a low activity level. For example: someone who manages steps
  and slopes but walks limited distances and may use a stick or other gait aid.
• K3, Suitable for general outdoor use, but
  not including sports and other high impact activities. i.e. someone who walks in most commonly
  encountered environments, at varying speeds, long distances when required and usually without a
  gait aid.
• K4, Suitable for high impact use. For those people who have unrestricted mobility and may
  impose higher than usual forces on their prosthesis, e.g. sports, manual work.

Preparing your home after lower limb amputation

• Remove mats on polished floors and tiles. They are a nuisance for wheelchairs and also trip hazards for prosthetic legs
• Handrails for stairs can assist with balance and stability
• Furniture like coffee tables and hall tables can be challenging to navigate around; place them near
  walls and out of the way of the main thoroughfare
• Anti-slip mats for the shower/bathroom floor are safer options and the use of a shower stool, chair or bath-seat can help to prevent trips and falls. Your occupational therapist will discuss the option of grip bars in the wet areas (such as the shower, bathroom and toilet).
• Arrange things to be in easy reach so that you are able to do things for yourself
• Make sure lighting is adequate
• Keep the pathways free of clutter or obstructions like piles of laundry or toys
• Be careful around pets, uncontrolled collisions can result in falls

Tips for upper limb amputees

• Regular shoes laces can be exchanged for specialized laces or alternatively you can use shoes which do up with Velcro.
• Devices such as a combined knife/fork can make eating easier for upper limb amputees using one hand to eat
• Specialized computer keyboards are available for people with one arm.
• Specialized boards are available to make things like cutting, chopping
• Specialized devices are available for opening jars easier to manage.
• Some amputees will opt for Velcro instead of studs or buttons to enable them to dress themselves

Driving

• Driving may be an important part of your independence. If you have medical approval and your
  health checks out you will be able to have your license re-instated. In some states/territories people
  are required to be re-tested for their driver’s license and/or have restrictions placed on their
  licenses such as: ‘automatic only’ vehicles.
• Vehicles can be modified to suit your needs and there are a number of companies which specialize
  in the re-fit of left-foot accelerator pedals, wheelchair hoists and the installation of spinner knobs
  or hand controls. Some people even manage to ride their motorbikes again. Push bikes and
  motorcycles can also be modified if required.
• The modification of a vehicle can vary depending on the age of your car and the state you reside
  in. Some states offer financial support via their aids and equipment programs.

I offer the following links for amputee resources.

• Inspirational Stories of Amputees overcoming their problems
  https://www.amputeeresources.com/resources
• The Amputee Coalition: https://www.amputee-coalition.org/about-us/
  • from their website “The Amputee Coalition is the nation’s leading organization on limb loss, dedicated to enhancing the quality of life for amputees and their families, improving patient care and preventing limb loss. With the generous support of the public, we are helping amputees live well with limb loss, raising awareness about limb loss prevention and ensuring amputees have a voice in matters affecting their ability to live full, thriving lives. The Amputee Coalition is an organization of 350 small groups who have trained over 1000 certified peer visitors across the US to teach fellow amputees about their options and offer peer support. Only an amputee can fully understand the challenges another amputee will face. Through peer to peer education and counseling the Amputee Coalition seeks to improve the lives of fellow amputees.“
• Southern Nevada Center for Independent Living https://sncil.org
  • The stated goal of the Southern Nevada Center for Independent Living is to be committed to “Removing Barriers Preventing Independent Living” by providing services designed to empower people with disabilities to:
    • Make individual choices
    • Assume responsibility to direct their lives
    • Manage their own affair
    • Fulfill social roles
    • Achieve independent lifestyles in the community

4100 North MLK Blvd.
Suite 100
North Las Vegas, NV 89032
Email: sncil2@aol.com
Phone Numbers:
Local: (702) 649-3822
Toll-free: (855) 649-3800
Fax: (702) 649-5022
Accessible: (702) 649-3822
Accessible Phone Type: TTY

• Nevada Department of Vocational Rehabilitation https://detr.nv.gov

The Department of Employment, Training & Rehabilitation (DETR) is the state’s lead workforce
development agency. It consists of divisions that offer workforce related services, job placement
and training, services for people with disabilities, investigation of claims of discrimination,
unemployment insurance benefits, labor market data and more. Many of these services are
provided through Nevada JobConnect career centers.

• Department of Health and Human Services Aging and
  Disabilities Services Division http://adsd.nv.gov/Programs/Seniors/ADRC/ADRCProgram/ Mission Statement The mission of Nevada Care Connection is to streamline access to services and ensure that Nevadans receive individualized care that meets their needs. The vision is that Nevadans with functional limitations and the family members that support them have timely access to correct information and quality services that promote choice, dignity, and independence.

• Benefits.GOV https://www.benefits.gov/benefit/699 outlines the application for US government benefits for amputees and those with disabilities.

Ronald Hillock MD
Fellow American Academy of Orthopedic Surgeons
Diplomat American Board of Orthopedic Surgery
Adult Reconstruction and Orthopedic Oncology