Questions and Answers - Rehabilitation Practitioners Inc.

Questions and
Answers
For the
Recent Amputee
www.RPIonline.us
[email protected]
Rev 1/09 JKC
Rev 1/09
Forward
I woke up one morning to a very different day.
I could not believe it; my foot had been taken away.
There were things in my life I was sure I could not do.
I was sure there were others who felt the same way too.
I had to learn to adjust to people and the way they looked.
I felt like a side show because I had lost my foot.
My eyes were opened with love from my wife.
She helped me to realize that I still had a life.
She had me do things I didn’t think I could do.
And with her love, I learned to make it through.
I then joined a support group and to them I want to say
that you all helped me to live from day to day.
If there is one thing that I would like to share,
I would tell those like me that there is life out there.
Never let the disability in your life get you down.
If you think it can’t be done, take a good look around.
Live out your life. Do all that you can do.
When things look their worst, This is what you do.
In my many years working with amputees, I have learned that information and knowledge empowers. Having questions answered allows us
to form future expectations and goals that can help us focus on the
positive. I hope this booklet provides honest and simple answers
that will assist you through the initial phase of adjusting to life as a
“differently-abled” person.
The loss of a body part is a major, life changing event. There will
certainly be physical challenges to overcome as you proceed through
the rehabilitation process. What is often overlooked is the emotional
aspect of dealing with the loss of amputation.
Grieving after amputation loss is a normal emotion experienced by
most amputees. Grief is experienced in various stages. Each of us
grieves differently and for various lengths of time. Bargaining often
occurs before amputation loss. When amputation is first discussed and
is a likely outcome, those faced with the possibility of losing a body part
may attempt to make deals (often with God) to save and heal the limb.
Denial may be the first phase following surgery. It is simply ignoring the
loss, pretending it didn’t happen. Many new amputees cannot initially
look at their residual limb because seeing it makes the situation become real. Once reality sets in, so does the anger stage. Amputees
may blame others for their loss and direct their anger inappropriately
toward those they love. Depression is the stage of grief that often
lingers and can be very overwhelming. Talk with a friend, your spouse
or family, your doctor, a pastor or our local amputee support group.
Seek professional help if necessary.
Never think it’s over, as if there’s nothing left to do.
Just put God in your life, He will see you through.
Acceptance is the final stage of grief. Accepting the loss involves
finding the good that has come from the ordeal, finding comfort and
Carson
a positive self image and focusing on personal growth. The stage of
acceptance is when your soul begins to heal.
Joan K. Cestaro, C.P.
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General Information
TERMINOLOGY
Residual Limb– the remaining portion of your limb
Prosthesis– artificial limb
Prosthetist– Practitioner who fabricates and fits artificial limbs
PRECAUTIONARY ADVICE FOR SAFETY
New amputees have been known to wake in the middle of the
night and, while still half asleep, forget that their leg has been
amputated. They begin walking to the bathroom and fall. Place
a chair beside your bed so that it blocks you from getting out of
the bed. A strategically placed object will act as a reminder not
to begin walking and is an important safety precaution.
AMPUTATION STATISTICS
Every year in the USA, 185,000* individuals undergo amputation.
Monthly, over 15,000 people have an extremity amputated.
(Amputation of extremity, excluding fingers and toes)
That is nearly 3,600 individuals each week.
Today in USA, about 500 people, just like you, will lose a limb.
DATA SOURCE: National Health Interview Survey, Vital Statistics Report, Series 10, No. 200
WILL I ALWAYS HAVE TO USE A CANE OR WALKER?
This depends on many factors, especially your overall balance.
You will likely need to use an assistive device for safety while
first learning to use the prosthesis. However, many amputees
learn to walk completely unassisted.
I WOULD ENJOY SPEAKING WITH OTHER AMPUTEES
The Winchester Amputee Support Group meets each month at
the Winchester Rehabilitation Center. It is a small, informal
group made up mostly of amputees and spouses. Talking with
the members of this group can give you invaluable insight into
life as an amputee. These are individuals who can truly understand what you are experiencing. For more information, contact
RPI at 540-722-9025.
WHERE ELSE CAN I GET MORE INFORMATION?
The Amputee Coalition of America (ACA) is the national
information and education center. They are an excellent
resource for amputees.
Amputee Coalition of America
900 East Hill Ave, Suite 285
Knoxville, TN 37901
Toll free @ 1-888-AMP-KNOW
www.amputee-coalition.org
You can find additional links at this site.
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WILL I BE ABLE TO DO ALL THE THINGS I USED TO DO?
As an amputee, you will have some limitations and will find
different ways to do certain things. Prosthetic technology has
become so advanced that some components of the prosthesis
can be tailored to specific activities. Prosthetic hands can be fit
to accommodate tools, kitchen utensils, ski poles and a variety
of other devices. Feet are not only designed for walking, but can
accommodate running, jumping, swimming, golf, skiing, etc.
Discuss your goals and ambitions with your Prosthetist.
Pre-Amputation
WHY DO I NEED AN AMPUTATION?
Amputation is almost always performed to save one’s life and is
a last resort when medicines and other surgeries have failed.
There are many reasons for amputation- trauma, infection,
diabetes, arterial or vascular disease, cancer and many others.
IS AMPUTATION PAINFUL?
CAN I STILL DRIVE A CAR?
If you are amputated on the left side, you should have little
change driving an automatic transmission vehicle. If amputated
on the right side, your vehicle can be fit with a left foot accelerator (gas pedal)- shown below. Hand controls can also be utilized. Contact your car insurance company and the Department
of Motor Vehicles
prior to driving to
assure you have met
the criteria for any
federal or local
regulations. You may
also inquire about
handicapped license
plates.
Page 12
Each person has a different tolerance for pain. Amputation, like
any other surgery, involves discomfort. Request pain medication
when you need it. You will likely be up and out of bed within a
day or two after surgery. This activity speeds the healing process
and ultimately decreases the pain.
IS IT NORMAL TO BE AFRAID?
Surgery is frightening. A life altering event is intimidating. And
you are facing both. Of course you will have fears. If you are
having difficulties coping, please find someone with whom you
can share and express your fears.
Many amputees return to a full and active lifestyle, enjoying all
their previous hobbies and activities. If your overall health is
good, you may be walking independently with your prosthesis
within a few months.
Page 3
WHAT IS PHANTOM SENSATION? WILL I EXPERIENCE THIS?
HOW LONG UNTIL I START WALKING WITH A PROSTHESIS?
Phantom sensations are feelings in the part of the body that has
been amputated. These sensations can be tingling, coldness,
itching, pain or the feeling of movement in the amputated part.
Phantom sensations are generally strong in the first few weeks
following surgery and gradually become less frequent and intense.
They often go away completely.
Your surgical site needs to fully heal before a prosthesis can be
started. The swelling in your residual limb must also be stable.
Healing time depends on many factors and your overall health
status, but generally takes 6-8 weeks.
Phantom sensations can be painful. Do not be afraid to ask for pain
medication if you are experiencing painful phantom sensations–
pain in the part of the body that is no longer there. It is real pain and
this sensation is not uncommon.
WHY DOES MY RESIDUAL LIMB LOOK SO BIG?
Swelling always occurs after surgery. Your residual limb will be
swollen at the incision end. As the swelling decreases over the
next few weeks, it will get smaller and more cylindrical.
.
A typical below the
knee residual limb a
few months after
amputation (average
sized male).
The process of making a prosthesis varies with it’s design, but can
be fabricated within a few weeks. Every prosthesis is completely
customized for an individual amputee. It is custom molded to your
residual limb and components are selected according your individualized needs. You will have several fittings and follow-up
appointments with your Prosthetist to make sure it fits correctly.
After the prosthesis is fabricated and
fit, a physical therapist will train you to
correctly use the prosthesis. You will
learn to walk, use stairs, get in and out
of a vehicle, and maneuver everyday
obstacles such as curbs and inclines.
This rehabilitation process varies
depending on your strength and is usually a several week process.
Mr. Lewis Haines of Stephen City, VA,
is missing both of his legs below the
knee. He walks in our parallel bars
while being fit for his bilateral (both
sides) below-knee prostheses.
Page 6
Page 11
HOW DOES A PROSTHESIS STAY ON?
HOW WILL I TAKE A SHOWER?
There are several ways to
suspend a prosthesis. The most
common method includes rolling
a gel liner onto your residual limb.
The liner is like a thick sock that
has soft, protective gel on the
inside. It is held onto your
residual limb securely.
Showers and tubs are very slippery. Falls can cause serious injury
and delay your progress. Install secure grab bars. Be sure the bath
or shower surface has nonslip adhesive strips or a secured, suction
cup mat. You should shower while seated. You can buy a plastic
step stool or a plastic camping chair with holes in the seat for drainage. Both can be purchased from a department store for under $10.
HOW CAN I DEAL WITH PEOPLE STARING AT ME?
This is a very common concern among amputees. Most people,
including yourself, take a second glance at anyone who looks
different. It is human nature. Glances and questions are due to
curiosity and are generally not meant to be hurtful. Answer questions honestly and people can learn from you. As you begin to feel
more comfortable with your changes and your body, others will feel
more comfortable around you.
At the end of the liner is a pin
that locks into a hole inside the
prosthesis and suspends it to
your body.
HOW CAN I TELL PEOPLE THAT I DON’T NEED THEIR HELP?
WILL I HAVE TO WEAR SPECIAL SHOES WITH A PROSTHESIS?
Most prostheses are made to accommodate a certain heel height of
shoe. You will provide the shoe. Any other shoe with the same heel
height may be worn. You can change shoes on a prosthesis very
easily. A tennis shoe or walking shoe is recommended for maximum
stability, balance and control.
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It is common for new amputees to become frustrated with the
constant desire of others to assist them. What appears as people
“showing pity on you” is good natured people offering a kind gesture.
Although you may be perfectly capable of doing it yourself, acknowledge that others want to help. Holding the door open for the person
behind you is mannerly and polite. Consider what you would do if
the roles were reversed.
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WILL I GET AN ARTIFICIAL LIMB?
HOW AM I GOING TO PAY FOR A PROSTHESIS?
There are many factors considered when
determining if you will get a prosthesis. Your
overall strength, health and pre-surgery
status are important. The amputation level
and your attitude and determination are also
considered. A prescription is required for a
prosthesis, so discuss any concerns with
your physician.
Many insurance companies, including Medicare, provide partial
to full coverage for prostheses. If you have concerns, contact
them directly. If you are uninsured or if your medical insurance
does not pay, there are other options for coverage. Because of
your amputation and the bills that follow, you may be eligible for
federal or state assistance. Request a meeting with the hospital
Social Service Department if you have additional questions.
WHAT CAN I DO TO PREPARE FOR A PROSTHESIS?
IS AN ARTIFICIAL LIMB HEAVY AND UGLY?
The most important aspect of preparing the residual limb is to do
the exercises that the physical therapist showed you. These exercises strengthen and prepare the specific muscles that will be used
to control your prosthesis. Touch and massage the end of your
residual limb often. The more you massage it, the less sensitive it
will become. This will make walking with a prosthesis more comfortable.
A prosthesis can be very real looking and cosmetically pleasing.
They can be designed so they are barely noticeable, especially
under clothing. They are custom shaped to match your existing
leg. The actual weight of the prosthesis
varies depending upon the components
used and generally weigh only 2-3
pounds.
A shrinker sock may be provided a few
days after your amputation. This special
stretch sock is designed to properly shape
and shrink your residual limb to prepare it
for prosthetic fitting. It is extremely important that you wear this shrinker sock constantly, day and night, removing it only to
wash your limb. Request two socks so
that you have one to wash and one to
wear.
Page 8
Marjie Sherman of Mathias, WV,
shows off the cosmetic appearance
of her prosthesis as she jokingly
asks, “Guess which one is real?”
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