Information for the new amputee
 

Here are some tips for the new amputee.

1.     Try to talk to another amputee with the same level of amputation, age, activity level etc. You'll be dealing with many emotional issues. Try not to be a "woe is me" type. Don't let emotional issues get to you. You can get sympathy from family and friends. But family and friends can't provide relevant information, tips, and the kind of camaraderie you can get from fellow amputees. To find other amputees check with your doctor, nurses, hospital, rehab center, or prosthetist.

2.     Don't do anything along medical lines without consulting a professional. If their advice sounds "weird" you should get a second or third opinion from other reliable sources.

3.     Place commonly needed items in easy reach. Keep frequently used food on the lower shelves of the refrigerator. "Reach & grab" tools are inexpensive and are available through several rehabilitation and therapy mail order sources.

4.     Explain to your family and friends that, when you need help, you'll ask for it - and then ask when you need it! No one is truly independent. We don't grow our own food; we depend on farmers. We don't build our own furniture, refrigerators or cars; we buy them, have them made, or get them serviced by others. We are all       interdependent!.

5.     All major changes take time to adjust to. Don't give up! All of us (not just amputees) feel blue now and then. Sometimes we go to our pity- party but then we come home again. However, do not hesitate to seek professional help if you're becoming very depressed. Reluctance to seek help can be dangerous.

6.     Regardless of the reason for your amputation, get on with your life. Ignore apparently well meaning people who say things such as, "I knew a person who lost both arms and both legs and dances ballet while performing brain surgery." Even worse are the folks that say,       "Your Great-Aunt Joan (or Uncle Bob) had the same surgery and she (or he) became a total invalid. It was such a burden on the family." These folks have no idea what they are talking about. Their "insight" is second hand, or worse, simply wrong.

7.     It's okay to be a little self-centered for a while. Give yourself a treat (see 21, below.)

8.     Set realistic goals and a reasonable time to reach them. If you don't achieve them, don't think you have failed. You just need to adjust the goal or the time frame and try again.

9.     Keep up with your interests and hobbies. If you can't do them for the present, then at least read magazines about them. Just because you can't do something right now, doesn't mean it's out of reach for the future.

10.   Don't become obsessed with being an amputee. While, initially, being an amputee can be time and attention consuming, do the best you can to return to your pre-surgery life style.

11.   If you can manage to put people at ease they'll usually treat you normally. When you encounter a person who hasn't seen you since your surgery, talk briefly about the amputation at an "appropriate" moment, and then let it go. This way, you aren't wondering, "When are they going to ask about my (arm/leg)," and they're not fixated on "I wonder what happened to (him/her)." Clear the air and then just be yourself. There is more to you than arms and legs. Those are only parts, not the whole of your being. The bigger you make your amputation the bigger others will make it, too.

12.   When the time comes for your first visit to the prosthetist, go prepared with a list of questions. Write them down as you think of them. It's hard to remember what you wanted to ask when you're apprehensive about being examined. Ask questions and jot down the answers. (Same thing goes for the doctor's office.)

13.   If you don't feel comfortable with any of your medical team get someone else. You're the boss!

14.   If you have a computer or have access to one, you can use it to get information:... amputee Groups, you find them in Yahoo, msn... or even on icq.

15. Eliminate as many "traps" in and around your house as possible if you use crutches. These might include small throw rugs, chairs that are not pushed under a table, telephone or electrical wires, etc.

16. Install slip protectors in the tub or use a non-skid tub mat.

17. Use a shower stool and install grab bars if possible.

18. Never walk without foot protection on your sound leg. Stepping on even a small pebble accidentally brought indoors could cause you to flinch and could result in a fall.

19. If you are facing a non-emergency amputation, seek a surgeon who knows how to construct a good residual limb. A prosthetist is probably your best source of information about who the most artful surgeons are.

20. You can expect this to be a trying time for you, your family and your friends. Always feel free to discuss your feelings. Don't wait until you're ready to explode. It will usually be at the wrong person!

21. Try to give yourself something to look forward to each day, even if it's only for a half an hour. It can be watching a TV show or video, reading, listening to music, talking online, sending an e-mail or even taking a nap! Find ways to reward yourself for hanging in there!

The Effects of Limb Loss on Sexuality

  The good news is that the physical consequences of limb loss almost never prevent sexual activity. The bad news is that limb loss often brings about such profound changes in one's self-image and emotional well-being that it does damage one's view of oneself as a sexual being and it can, therefore, inhibit development of intimate relationships. Thus, the problem, if there is one, is almost always emotional -- not physical.

  The physical consequences   When there are physical consequences that adversely affect intimacy, they are usually reported to be pain, fear of further injury, and general physical debility. The presence of residual limb pain and its potential effect on intimacy-- especially during the healing period--requires no elaboration. Fear of further injury is probably related to the potential exacerbation of pain, since once the healing period is past, intimacy is unlikely to cause further injury. General physical debility is another matter, however.

  Mourad and Chiu, in reporting on marital-sexual adjustment of amputees in the February, 1974, issue of Medical Aspects of Human Sexuality, studied 12,000 new amputees. The majority of the individuals studied (58 percent) had their amputations due to disease, of which diabetes and/or arteriosclerosis were predominant. The results are not surprising. The great majority of the amputees in this group were older and/or chronically ill. Many of the males were impotent and many of the females reported a complete absence of orgasmic response.

  It's important to repeat at this point, that there is much more to sexuality and physical intimacy than sexual intercourse. Pain, fear of further injury, and chronic illness need not, in and of themselves, have an adverse effect on the numerous other avenues of sexual expression, such as giving and receiving pleasure, sharing intimacy and affection, and communicating deep feelings

  The remaining 42 percent of the individuals studied by Mourad and Chiu had their amputations because of tumors or trauma, and the majority of these were under forty years of age. Most of the sexual dysfunction reported by this group had its roots in emotional areas - fear, anxiety, and feelings of unattractiveness.

  The emotional consequences   Ellen Winchell, Ph.D., in her book, Coping with Limb Loss, poses the following questions:

  • Can a male with limb loss, whose work once included hard physical labor, accept a desk job and feel just as masculine?
  • Can he feel just as manly if he can no longer participate in rough-and- tumble sports in the manner he used to?
  • Can a woman who interacts with the public feel feminine if she is missing an arm?
  • Can she feel womanly if her residual limb or prosthesis is readily visible to her mate or others?

  Dr. Winchell's implied answer is, "maybe not," and in support, she cites the far-reaching effects of self-confidence and self-esteem in shaping one's sexual identity.

  Altered physical appearance frequently results in lowered self-esteem among people with amputations. They can feel "handicapped" by their perceived inability to compete with the "normal" members of their sex for a mate. "After all, who wants a "damaged" partner?" Women who have been preoccupied with their appearance express fear that they are "no longer attractive" and will neither be able to marry nor hold on to a partner they already have. They tend to feel their residual limbs are ugly and should be hidden by clothing or a prosthesis. And the notion of being seen unclothed is so abhorrent that they cannot even contemplate intimacy.

  Not being able to participate in previously enjoyed activities, such as sports or hiking can also affect one's feeling of confidence and completeness--especially if it is seen as likely to damage an existing relationship.

  Real or imagined rejection by those of the opposite sex can reinforce these feelings of inadequacy and low self-worth. Unfortunately, some people with limb loss do experience rejection which is attributable to their amputation. Others, motivated by their lowered self-confidence and self- esteem imagine they have been rejected when they have not, or attribute rejection to their amputation when other factors may be the actual reasons.   As Dr. Winchell points out, it is difficult for one to be loved by others if one does not love oneself. It is unfortunate that the physical alteration that results from amputation prevents many with limb loss from loving themselves.

  What is to be done?       Fortunately, most people who experience limb loss accompanied by the feelings of inadequacy and loss of sexuality discussed above, recover with the passage of time. When they are able to reach acceptance--the final stage of the grieving process--they find their self-esteem and self confidence restored. They can think clearly about themselves once again. They realize that, in Dr. Winchell's words, "The totality of who a person is holds far greater importance than does his or her loss of limb." They realize their brains, personality, and sexuality are not in their arms or legs. They realize that the willingness to accept the loss of a limb shows an admirable depth of character and strength. Those who share the life crisis of amputation with their partners realize that sharing the loss and recovering together can serve to strengthen their love and commitment to each other.

  For others, time, bravery, clear thought, and a sense of humor are not enough. Outside help is needed to restore their emotional resources. For some, support group participation will help. It is clearly useful to be able to share fears and experiences with others in the "same boat." Some will seek general psychological counseling, and still others will seek treatment by a sex therapist.

  Here are some other suggestions from Coping with Limb Loss:

Involve your partner in your recovery - It can be helpful if your partner can become comfortable with viewing and touching your residual limb as early as possible. Talk with your partner about your fears and expectations for your recovery. Laugh together. Cry together. And recover together.

Experiment with body positioning - Explore and discover what changes in position are necessary to restore comfort and balance during intimacy. Deciding who should be on top and who should be on which side of the bed is often sufficient accommodation.

Place less emphasis on performance - Learn that mutual pleasure is more important than performance. Let go of societal "norms." Let go of theguilt and shame of being different. Understand that it's frequently easier for others to accept your differences than to accept them yourself.

Realize that sexuality is more than intercourse - Give yourself permission to broaden your definition of sexual expression. Be creative. Experiment. Whatever works is okay.

Keep the lines of communication open - Don't make assumptions about intimate matters based on fear or insecurity. Open discussion of expectations, concerns, and physical capabilities is vital.

  As one individual with multiple amputations expressed proudly to me, "I am unique. I am not like anyone else in the world. I've found my different body to be an advantage. People remember me and many doors have opened for me because of that. I've met many stimulating people I would never have met if I weren't unique. I like my body. It's the only one I'll ever have. I take pains to keep it attractive by eating correctly and getting regular exercise."

  What a wonderful outlook and healthy philosophy!

Disabled Persons' Parking Information

Among those eligible for disabled parking privileges are those who have,"Loss, or loss of the use of, one or both lower extremities," and "Loss, or loss of the use of, both hands." (Although the law provides privileges for the loss of both hands only, there is considerable evidence that many DMV offices have voluntarily granted privileges to those who have lost onehand.)

  Since an amputation is not a temporary disability, amputees are eligible for either special permanent license plates (showing a wheelchair symbol) or parking placards which can be renewed when they expire every other year. The permanent license plates are available at no cost (other than the normal vehicle registration fees) and parking placards are available and renewable for a fee of $6.00.

  Amputees may apply for disabled parking privileges either in person at a DMV or AAA office, or by mail. (If applying by mail, a physician's certification of the disability is required.) Ask for and complete the form entitled, "Application/Statement of Facts for Disabled Person Parking Placard or Plates."

  Since amputations are disabling conditions that can be seen by the DMV employee who processes the application, amputees who apply in person do not need a physician to certify their disability but, instead, are able to self- certify. If you have to point this out to the representative who processes your application, remember that there is wording in section G. of the application form (Doctor's Certification of Permanent Disability) that covers amputees' right to self-certify.

  Naturally, the parking placard must only be used by the disabled person to whom it is issued. When applying for permanent license plates, the vehicle must either be registered to the disabled person, or a Statement of Facts must be provided by the registered owner that the vehicle will be used at least 51% of the time to transport the disabled person. Both parking placards and license plates must be surrendered upon the death of the disabled person.

  Parking placards and disabled license plates enable the disabled person to park in blue "handicapped" parking spaces and at parking meters without the need to put money in them. Disabled parking privileges do notextend to red or yellow zones, or to white zones for longer that the posted time limit. Also, signs indicating "X Hours Parking Only" must be obeyed.

  Parking placards and disabled license plates also entitle the disabled person to have gasoline pumped for them at self-service islands except at stations where there is only a cashier present.

  Many public parking lots and garages, such as those at County beaches and at some hospitals, offer free parking to those with placards or special plates. It's always a good practice to call the parking attendant's attention to your placard or plates, since they may fail to notice them otherwise.

  If you receive a parking citation because the parking enforcement officer apparently did not see your placard, you may mail the citation to the address indicated, together with a note of explanation. Be sure to include the placard number. The safest practice is to take the citation to the police department that issued it and ask that it be canceled. If you receive a citation because you forgot to display your placard, the issuing departmentmay elect to cancel it, but they are not required to.

  Although many people report that they have successfully used their placards and special plates outside the state of California, if you are planning such a trip, the safest practice is to check with the other state(s) in advance.

  If you see a vehicle illegally parked in a "handicapped" space, you may call the local police or parking enforcement. The appropriate numbers can be found in the telephone book's "Government" section. The law provides for fines and towing for violators, although towing is seldom done. Approaching the violator yourself is not encouraged. Those insensitive enough to use a "handicapped" space wrongfully are also apt to be rude and aggressive.

COPING WITH A LEG AMPUTATION



  You are not alone. There are hundreds of thousands of people with amputations in the United States. Although amputation can be a significant disability, most have learned to lead happy, productive lives since their surgery.

  The term "amputee" describes a condition, not a person. You are in reality a "person" who happens to be missing one or more limbs. You may dislike the term "amputee" at first, but you'll probably use it to describe yourself eventually. Just remember, inside you're the same person now that you were before you lost your leg.

  Leg amputations are called by different names. Above-knee and below- knee amputations are named after the bones they transect, namely "trans-femoral" and "trans-tibial" respectively. They are also commonly referred to as "AK" and "BK." Amputations at the joints are called "disarticulations," as in "hip disarticulation." Loss of one leg is called "unilateral" and loss of both is called "bilateral."

  The part of your leg you have left is commonly called a "residual limb," although some people use the term "stump." You can use either term you prefer.

Coping With the Emotional Pain

  An important thing about amputation is that it permanently and visibly takes away a part of your body. For this reason, it's common for people with new amputations to grieve the loss of the limb as they would mourn the loss of a loved one.

  It's normal for people with amputations, no matter how well they might have tried to prepare themselves, to go through this period of grieving before they can fully accept their new situation. This adjustment period can be emotionally painful, but it's completely normal, and absolutely necessary to deal with.

  In general, your adjustment may be more difficult the more severe (i.e., higher) your amputation is, if your amputations are bilateral, and if you must rely on others for help with your daily living needs. Also, the shock tends to be more severe if your amputation was the result of an accidentand you didn't have time to prepare emotionally, or if you expect your life to be profoundly affected.

  It's entirely normal for you to experience anger, increased demandingness, intolerance, and frustration during this time. Despair, introspectiveness, and withdrawal -- even short term depression -- are also common, as are feelings of agitation or "jitteryness." You may be alarmed by these feelings, but there's no need to. Only if these feelings persist, do some professionals advocate seeking psychological help.

  Not only are there physical challenges and doubts about the future to be dealt with, but since most of us tend to equate who we are with being physically "complete," we may see the loss of our limb as striking at our very self-image and identity. A positive self-image and an understanding that your attractiveness to others is based on your personality, intellect, sense of humor, and personal values--not how many legs you have--will be the most significant factor in your emotional recovery!

  As with grieving over a death, mourning the loss of a limb is said sometimes to occur in stages. These may include:

  •   A shock stage, during which it seems like it's just too enormous a problem to think about at all.
  •   A denial stage, during which you may refuse to believe, on an emotional level, that your leg is really gone. You may also avoid thinking about the loss altogether, or tell yourself, "It's no big deal."
  •   An anger stage, during which you may feel compelled to find something or someone to blame, or simply to be furious with everything and everyone for apparently little reason.
  •   A depression stage, during which you may feel it's no use going on, or during which you can't seem to concentrate or become interested in anything.
  •   And, finally, a time of acceptance, during which you find that the anger and depression go away and you are able to make plans to get on with your life.

  You should understand that these stages may not occur in the order they're listed above. Also, don't expect that you'll go smoothly from one to the other, or that you'll never return to a stage you thought you had finished with. But, you must also understand that all of this is normal, countless others have gotten through it, and you will, too.

  During this time your family can be of great help, as can the social worker assigned to your case and visitors from your local amputee support group. Most social workers are trained in helping patients through the grieving process, and most support groups can send experienced people to visit you to share concerns, answer questions, and assure you that a return to an active, productive life is an attainable goal.

Phantom Sensation

  When a limb is removed, the brain is inclined to believe it's still there and to continue to sense the presence of the limb. This is referred to as "phantom limb sensation." Until you get used to it, you may catch yourself trying to take a step with your missing foot.

  Phantom limb sensation is not a true pain, but it can be disconcerting if you don't know that it's completely normal and that you can expect to experience it. Sometimes it may feel like your foot is growing directly out of your residual limb or that the missing part is much larger than it should be. Sometimes the missing limb feels "tingly" or "on pins and needles," or part of it may cramp or itch. If the sensation ever becomes disconcerting or excessively uncomfortable, many people have found that they are able to ease it off by thinking about something else, by massaging their residual limb, or simply by ignoring it.

Phantom Pain

  While phantom limb sensation is a feeling that the limb is still present, phantom pain is actually painful. Frequently, phantom pain is experienced as a feeling that the limb or a part of it is on fire, or that it's twisted in an uncomfortable position. Phantom pain can be temporary or it can last longer. It is more likely to occur if your leg was painfully diseased or badly injured before it was amputated.

  The causes of phantom pain are varied and not understood precisely. The phenomenon is generally thought to occur because the nerves that                                               3carry signals from the amputated part to the receptors in the brain are still intact, but they carry "wrong" signals because the part is no longer there.

  There are many treatments for phantom pain, ranging from the simple application of heat, cold, or massage, to complicated surgical procedures, which most people rightfully avoid. If you are bothered by phantom pain, the best thing for you to do is talk to other people with amputations and try the simple treatments that have worked for them. Then consult your physician if none of those relieves your discomfort.

Your Rehabilitation

  One way to look at "rehabilitation" is that it entails both a psychological and physical accommodation to a new reality. Psychological rehabilitation must be underway before physical rehabilitation can take place. Psychological rehabilitation might be defined as the ability to adjust mentally and accept the new circumstances. Physical rehabilitation might be defined as a return to a regular life style, based on what compromises you are willing to make in what you want to be able to do or what you mustdo. The most healthy way to set your rehabilitation goals is based on whatyou think is best for yourself, not on what others think you should look like or be able to do..

  The point is that when you are uninformed or when you let others define what level of functioning is "normal" or right for you, you lose control of your own rehabilitation. Then, if you fail to measure up to their standards, you will feel that you've failed as a person. It's hard enough to learn to live a full life after a leg amputation -- and even harder after two of them. You don't need to add to your difficulties by allowing others to tell you what level of rehabilitation is right for you.

  A good way to set realistic rehabilitation goals is to define what you mustbe able to do to accomplish the essential daily living and vocational tasks without help. Then define those tasks with which you are willing to accept help, assuming help is available. Then define those tasks you would like to be able to do independently. These are your rehabilitation goals.

  Finally, you will need to figure out what you have to do to attain your goals. This is your action plan. These kinds of things may include working extensively with a physical therapist, getting tips from others with similar amputations, purchasing or having made for you certain assistive devices, deciding to use artificial limbs, or learning to do without.

Preparation for a Prosthesis

  An artificial limb is called a "prosthesis." Before you select a prosthetist (a "prosthetist" is one who makes and fits artificial limbs) you will have to prepare your residual limb by shrinking and desensitizing it and by becoming as physically strong as you can.

  Residual limb shrinkage is accomplished by wrapping it with an elastic bandage or by wearing a "prosthetic shrinker," which is a tubular elastic sock which is pulled or rolled onto the residual limb. You may have been taught in the hospital to wrap your residual limb with an elastic bandage using a "figure eight" motion and to make it tighter on the end than at the top. If you were not taught this, you will want to ask your physical therapist or prosthetist to teach you, because if you don't wrap it correctly, you can cut off the circulation, doing more harm than good. Eventually, this wrap will shrink and shape the residual limb's muscles so a prosthesis can be used.

  Desensitization is required because the end of your residual limb and scar will probably initially be very sensitive to touch. Desensitization is accomplished by first tapping the sensitive area lightly with the fingers of your other hand. Later, you can rub the end of your residual limb lightly with a towel or wash cloth. Eventually, the sensitivity will go away.

  Exercises are necessary to regain and maintain full range of motion in your remaining joints and to re-strengthen the muscles in the remaining part of your amputated leg. Exercises to strengthen your arms and shoulders are also important, since you will have to rely on those muscles to use crutches and sometimes to transfer from one surface to another, If you haven't already been taught the proper exercises to do, you should consult your physical therapist.

Prosthetic Rehabilitation

  "Prosthetic rehabilitation" means resuming a normal life through the use of a prosthesis.

  You may have been fitted with an Immediate Postoperative Prosthesis (IPOP) when you were still in the hospital. Sometimes a physician will decide to cover your residual limb with a plaster cast instead of a soft bandage before you leave the operating room. (This is commonly done to manage expected postoperative swelling.) After a few days, the physician may decide to attach a metal post and a foot to the cast and "get you on your feet" using this IPOP.

  At any rate, after returning home for a suitable period of healing and residual limb preparation (see above) you will be ready for a "real" prosthesis.

  The first step in this process is the development of your prosthetic prescription. Your physician is responsible for approving this prescription, but it is a very good idea to have your prosthetist involved in writing it. This is because prosthetists usually know much more than physicians about what kind of prosthesis will be best for you. The important point to remember about prosthetic prescriptions is that you must explain fully to your physician and prosthetist exactly what level of activity you expect to return to after your rehabilitation. Artificial legs range from "basic" to "high tech" depending on what components are used to construct them. For example, if you were a healthy, active person before your surgery and fully expect to be able to resume your former level of activity, a "basic" leg will not serve you well.

  The first step in making your prosthesis will be to take measurements of your residual limb. Then, a mold of your residual limb will be taken by placing a plaster cast on it, carefully removing and reassembling the cast after it has hardened, and filling it with plaster. When that has hardened, the cast will be peeled away, leaving a plaster duplicate of your residual limb to be used in making the new prosthetic socket.

  The part of the prosthesis that attaches to your body is called a socket, and it's the most important part of the limb. Knowing what knees, feet, and such are available on the market might be called a science, but making a socket is an art. The reason is that every residual limb is different and your socket must be custom made to fit you specifically. Also, since an artificial leg must bear your entire weight and still feel as comfortable as possible, it must fit exactly, supporting your weight where it should and avoiding pressure in other areas.

  Your prosthesis can be held on in a variety of ways, such as with straps, a foam liner, a silicone sheath, or suction. The best way for you will be indicated in your prescription.

  Your prosthetist will probably make your first socket out of clear plastic so the way it fits can be seen through the clear socket wall. If the shape isn't exactly right, the prosthetist can make the necessary changes by re- heating and bending the plastic appropriately. When a proper fit has been achieved, a "temporary" prosthesis may be made. This is because your residual limb will continue to change shape and size for several more weeks or months. At the appropriate time, a "definitive" prosthesis will be constructed for you. A cosmetic covering--a piece of foam carefully carved to match the shape of your other leg--is usually provided. This is the prosthesis you will use every day until it wears out or otherwise needs to be replaced.

  The importance of training in how to use the prosthesis cannot be overemphasized. Your prosthesis is a tool, and like any tool, it won't do what it's designed to do unless it's used correctly. You will want to insist on receiving adequate training either from your prosthetist or physical therapist--or both.

  Also, you will want to watch your weight carefully. If you gain too much, your prosthesis may no longer fit--and buying a new, expensive prosthesis is a very different proposition than buying new clothing!

Care of the Residual Limb

  The skin and underlying tissue that typically ends up on most residual limbs after an amputation is pretty delicate and is subject to a number of problems, including irritation, further injury, and infection. Therefore, learning how to care for your residual limb is an important part of your rehabilitation.

  If you wear a prosthesis there may be special problems, such as rubbing or irritation caused by perspiration or swelling inside the socket. Usually these problems are relatively easily resolved by bathing the residual limb daily using mild soap and lukewarm water, by rinsing thoroughly with clear water, and by patting the limb dry rather than by rubbing vigorously.

  The inside of the prosthesis socket should also be cleaned daily, and if prosthetic socks are worn inside the prosthesis, they should be changed and laundered at least daily to avoid a build-up of irritating perspiration.

  If you use a prosthesis, inspect your skin daily, and if skin problems are found, promptly call them to the attention of your doctor so as to avoid developing more severe problems.

Work

  The issue of your career has psychological, as well as the obvious practical ramifications.

  Psychologically, the issue involves how strongly you have identified yourself with your career or vocation and whether or not your amputation will enable you to continue to engage in that line of work. Those whose work has become an integral part of their very identity and who have to give up that work because of their disability can suffer what is commonly called "an identity crisis." This can make them feel like they don't know who they are any more.

  If you are able to return to your job after your amputation, as many people can, you will probably have no trouble like this. But if you are one who sees yourself very strongly in terms of your work and you have to seek different work after your amputation, you will not be puzzled by the reaction you may have. Simply recognizing it for what it is can go a long way toward relieving the feelings.

Recreation

  Your amputation is no reason for you to give up sports or recreation. If you enjoyed snow or water-skiing, tennis, horseback riding, golf, swimming, or just the outdoors in general before your amputation, you can certainly continue that involvement afterward--either with or without your prosthesis.

  Many people have elected to participate in sports they didn't engage in before their amputations as a way to meet new people and to improve their physical conditioning.

Driving

  It will be possible for you to drive either with or without modifications to your car. In general, if you still have one healthy leg and an automatic transmission, you won't need modifications. If your right leg was amputated and you're not comfortable operating the accelerator with your left foot, an extension pedal can be installed so the accelerator can be operated from the left side. In general, most prosthesis users with below- knee amputations, even bilateral amputations, can operate a manual transmission without modifications.

  For those who have bilateral amputations and are not prosthesis users or those who are simply uncomfortable operating the pedals with their prosthetic feet, a wide variety of hand controls are available.

  If you will need vehicle modifications, you should contact your state department of rehabilitation for information about available assistive devices and where they can be obtained. Also, don't forget to contact people with the same amputation as yours through your support group to see how they do it.

Conclusion

  A final word about your rehabilitation: All amputations are disabling to some degree, and some are quite a bit more disabling than others. But you have a life to live and you will want to get on with it, making it as enjoyable and productive as possible.

  You will find that dealing with crutches, wheelchairs, and artificial limbs is frustrating at times and it will probably be harder to do the things you did easily before. But if you concentrate on what you have, rather than what you are missing, your life will return to a level of "normalcy" that may surprise you.

COPING WITH AN ARM AMPUTATION



  You are not alone. There are hundreds of thousands of people with amputations in the United States. Although amputation can be a significant disability, most have learned to lead happy, productive lives since their surgery.

  The term "amputee" describes a condition, not a person. You are in reality a "person" who happens to be missing one or more limbs. You may dislike the term "amputee" at first, but you'll probably use it to describe yourself eventually. Just remember, you're the same person now that you were before you lost your arm.

  Arm amputations are called by different names. Above-elbow and below-elbow amputations are commonly referred to as "AE" and "BE." Amputations at the joints are called "disarticulations," as in "shoulder disarticulation." Loss of one arm is called "unilateral" and loss of both is called "bilateral."

  The part of your arm you have left is commonly called a "stump," although some people prefer the term "residual limb." You can use either term you prefer.

Coping With the Emotional Pain

  An important thing about amputation is that it permanently and visibly takes away a part of your body. For this reason, it's common for people with new amputations to grieve the loss of the limb as they would mourn the loss of a loved one.

  It's normal for people with amputations, no matter how well they might have tried to prepare themselves, to go through this period of grieving before they can fully accept their new situation. This adjustment period can be emotionally painful, but it's completely normal, and absolutely necessary to deal with.

  In general, your adjustment may be more difficult the more severe your amputation is, if your amputations are bilateral, and if you must rely completely on others, at least initially, for help with your daily living needs. Also, the shock tends to be more severe if your amputation was the result of an accident and you didn't have time to prepare emotionally, or if youexpect your life to be profoundly affected. Thus, if you were an athlete or concert pianist, for example, you might be expected to have a more severe initial reaction than if your work is of a kind that will be less affected.

  It's entirely normal for you to experience anger, increased demandingness, intolerance, and frustration during this time. Despair, introspectiveness, and withdrawal -- even short term depression -- are also common, as are feelings of agitation or "jitteryness." You may be alarmed by these feelings, but there's no need to. Almost all people have them and they usually get over them in a relatively few weeks or months. Only if these feelings persist, do some professionals advocate seeking psychological help.

  Not only are there physical challenges to be overcome and doubts about the future to be dealt with, but since most of us tend to equate who we are with being physically "complete," we may see the loss of our limb as striking at our very self-image and identity. A positive self-image and an understanding that your attractiveness to others is based on your personality, intellect, sense of humor, and personal values -- not how many arms you have -- will be the most significant factor in your emotional recovery!

  As with grieving over a death, mourning the loss of a limb is said sometimes to occur in stages. These may include:

  •   A shock stage, during which it seems like it's just too enormous a problem to think about at all.
  •   A denial stage, during which you may refuse to believe, on an emotional level, that your arm is really gone. You may also avoid thinking about the loss altogether, or tell yourself, "It's no big deal."
  •   An anger stage, during which you may feel compelled to find something or someone to blame, or simply to be furious with everything and everyone for apparently little reason
  •   A depression stage, during which you may feel it's no use going on, or during which you can't seem to concentrate or become interested in anything.
  •   And, finally, a time of acceptance, during which you find that the anger and depression go away and you are able to make plans to get on with your life.

  You should understand that these stages may not occur in the order they're listed above. Also, don't expect that you'll go smoothly from one to the other, or that you'll never return to a stage you thought you had finished with. But, you must also understand that all of this is normal, countless others have gotten through it, and you will, too.

  During this time, your family can be of great help, as can the social worker assigned to your case and visitors from your local amputee support group. Most social workers are trained in helping patients through the grieving process, and most support groups can send experienced people to visit you to share concerns, answer questions, and assure you that a return to an active, productive life is an attainable goal.

Phantom Sensation

  When a limb is removed, the brain is inclined to believe it's still there and to continue to sense the presence of the limb. This is referred to as "phantom limb sensation." Until you get used to it, you may catch yourself reaching for things with your missing hand.

  Phantom limb sensation is not a true pain, but it can be disconcerting if you don't know that it's completely normal and that you can expect to experience it. Sometimes it may feel like your hand is growing directly out of your residual limb or that the missing part is much larger than it should be. Sometimes the missing limb feels "tingly" or "on pins and needles," or part of it may cramp or itch. If the sensation ever becomes disconcerting or excessively uncomfortable, many people have found that they are able to ease it off by thinking about something else, by massaging their residual limb, or simply by ignoring it.

Phantom Pain

  While phantom limb sensation is a feeling that the limb is still present, phantom pain is actually painful. Frequently, phantom pain is experienced as a feeling that the limb or a part of it is on fire, or that it's twisted in an uncomfortable position. Phantom pain can be temporary or it can last

longer. It is more likely to occur if your arm was painfully diseased or badly injured before it was amputated.

  The causes of phantom pain are varied and not understood precisely. The phenomenon is generally thought to occur because the nerves that carry signals from the amputated part to the receptors in the brain are still intact, but they carry "wrong" signals because the part is no longer there.

  There are many treatments for phantom pain, ranging from the simple application of heat, cold, or massage, to complicated surgical procedures. Very few people have to resort to surgical treatments, however. If you are bothered by phantom pain, the best thing for you to do is talk to other people with amputations and try the simple treatments that have worked for them. Then consult your physician if none of those relieve your discomfort.

Your Rehabilitation

  One way to look at "rehabilitation" is that it entails both a psychological and physical accommodation to a new reality. Psychological rehabilitation must be underway before physical rehabilitation can take place. Psychological rehabilitation might be defined as the ability to adjust mentally and accept the new circumstances. Physical rehabilitation might be defined as a return to a regular life style, based on what compromises you are willing to make in what you want to be able to do or what you mustdo. The most healthy way to set your rehabilitation goals is based on whatyou think is best for yourself, not on what others think you should look like or be able to do..

  The point is that when you are uninformed or when you let others define what level of functioning is "normal" or right for you, you lose control of your own rehabilitation. Then, if you fail to measure up to their standards, you will feel that you've failed as a person. It's hard enough to learn to live a full life after an arm amputation -- and even harder after two of them. You don't need to add to your difficulties by allowing others to tell you what level of rehabilitation is right for you.

  A good way to set realistic rehabilitation goals is to define what you mustbe able to do to accomplish the essential daily living and vocational tasks without help. Then define those tasks with which you are willing to accept help, assuming help is available. Then define those tasks you would like to be able to do independently. These are your rehabilitation goals.

  Finally, you will need to figure out what you have to do to attain your goals. This is your action plan. These kinds of things may include working extensively with an occupational therapist, getting tips from others with similar amputations, purchasing or having made for you certain assistive devices, deciding to use artificial limbs, or learning to do without.

Preparation for a Prosthesis

  An artificial limb is called a "prosthesis." Before you select a prosthetist (a "prosthetist" is one who makes and fits artificial limbs) you will have to prepare your residual limb by shrinking and desensitizing it and by becoming as physically strong as you can.

  Residual limb shrinkage is accomplished by wrapping it with an elastic bandage or by wearing a "shrinker," which is a tubular elastic sock which is pulled or rolled onto the residual limb. You may have been taught in the hospital to wrap your residual limb with an elastic bandage using a "figure eight" motion and to make it tighter on the end than at the top. If you were not taught this, you will want to ask your physical therapist or prosthetist to teach you, because if you don't wrap it correctly, you can cut off the circulation, doing more harm than good. Eventually, this wrap will shrink and shape the residual limb's muscles and prevent them from becoming "flabby" through disuse.

  Desensitization is required because the end of your residual limb and scar will probably initially be very sensitive to touch. Desensitization is accomplished by first tapping the sensitive area lightly with the fingers of your other hand. If you have a bilateral amputation, you will need help with this. Later, you can rub the end of your residual limb lightly with a towel or wash cloth. Eventually, the sensitivity will go away.

  Exercises are necessary to regain and maintain full range of motion in your remaining joints and to re-strengthen the muscles in the remaining part of your amputated arm and shoulder, including the opposite shoulder, which will be used to help control your prosthesis. If you haven't already been taught the proper exercises to do, you should consult your physical therapist.

  Even if you don't plan to use a prosthesis, it's still a good idea to do all of this, because you will need to use your residual limb to help you accomplish your daily living tasks.

Prosthetic Rehabilitation

  "Prosthetic rehabilitation" means resuming a normal life through the use of a prosthesis.

  Most people with leg amputations use prostheses. Most with arm amputations do not. This is because the functions of an arm and hand are much more complex than those of a leg and foot, and artificial arms aren't as good at replacing those functions as artificial legs.

  The things on the end of an artificial arm -- cosmetic hands (i.e., a hand that is shaped like a hand) and hooks (i.e., two hook-shaped steel rods) are called "terminal devices." Terminal devices have several motions -- opening and closing, rotation and flexion. Opening and closing are self explanatory, and are controlled by the person, either by a harness attached to the opposite shoulder or by electric motors. Rotation is a circular "twisting" of the wrist and can be controlled in the same ways. Flexion is the motion that "waves" the hand up and down. It is usually accomplished by moving the terminal device into the desired position with the other hand or by pushing it against the body.

  In general, hooks are considered much more functional than artificial hands, especially for manipulating smaller objects and doing rough work. Conversely, hands are generally considered more cosmetic. Some people feel it's more important for them to look "normal," so they wear a prosthesis with a cosmetic hand   Others are far less interested in how they look than what they are able to do, so they opt for the functionality of hooks.

  The chief drawback of all terminal devices is that they don't have any feeling. One person who wears a prosthesis part time says that using an artificial arm is like trying to do things with pliers on the end of a stick.

  Despite this, many people with arm amputations use and are satisfied with their prostheses. The important thing to remember is, what's right for you should be determined by your rehabilitation goals and the things that are important to you -- not what you think society expects you to look like.

  In general, the more arm you have left, the easier it will be for you to use a prosthesis As the site of the amputation moves upward toward the shoulder, however, range of motion, strength, and leverage decrease, as does the likelihood of getting the prosthesis to do what an ordinary arm can do.

  Prostheses can be body-powered or electric. In the former case, a cable connected to the terminal device -- and to the elbow joint, if your amputation is above the elbow -- is connected to your opposite shoulder and the prosthesis is operated by body movements.

  The electric arm, sometimes called a "myoelectric prosthesis," is operated by electric motors within the artificial arm. The motors are controlled by sensors inside the prosthesis socket that sense small electrical currents generated by nerves in the residual limb. This occurs when there is normal motion and related muscle activity in the residual limb.

  Each kind of prosthesis has its advantages and disadvantages, and you will want to understand them thoroughly before you decide to acquire one or the other.

Care of the Residual Limb

  The skin and underlying tissue that typically ends up on most residual limbs after an amputation is pretty delicate and is subject to a number of problems, including irritation, further injury, and infection that tougher skin resists. Therefore, learning how to care for your residual limb is an important part of your rehabilitation.

  If you wear a prosthesis there may be special problems, such as rubbing or irritation caused by perspiration or swelling inside the socket. Usually, these problems are relatively easily resolved by bathing the residual limb daily using mild soap and lukewarm water, by rinsing thoroughly with clear water, and by patting the limb dry rather than by rubbing vigorously.

  The inside of the prosthesis socket should also be cleaned daily, and if prosthetic socks are worn inside the prosthesis, they should be changed and laundered at least daily to avoid a build-up of irritating perspiration.

  If you use a prosthesis, inspect your skin daily, and if skin problems are found, call them to the attention of your doctor promptly to avoid development of more severe problems.

Work

  The issue of your career has psychological, as well as the obvious practical ramifications.

  Psychologically, the issue involves how strongly you have identified yourself with your career or vocation and whether or not your amputation will enable you to continue to engage in that line of work. Those whose work has become an integral part of their very identity and who have to give up that work because of their disability can suffer what is commonly called "an identity crisis." This can make them feel like they don't know who they are any more.

  If you are able to return to your job after your amputation, as many people can, you will probably have no trouble like this. But if you are one who sees yourself very strongly in terms of your work and you have to seek different work after your amputation, you will not be puzzled by the reaction you may have. Simply recognizing it for what it is can go a long way toward relieving the feelings.

Recreation

  Your amputation is no reason for you to give up sports or recreation. If you enjoyed water-skiing, tennis, horseback riding, golf, swimming, or just the outdoors in general before your amputation, you can certainly continue that involvement afterward--either with or without your prosthesis.

  Many people have elected to participate in sports they didn't engage in before their amputations as a way to meet new people, and to improve their physical conditioning as a means to help with their rehabilitation.

Driving

  It will still be possible for you to drive, either with or without modifications to your car. In general, if you can reach and operate all your car's controls either with your "good" hand or with the help of your prosthesis, or with your "good" hand and residual limb, you will not need modifications. Indeed, many people with bilateral below-elbow amputations can drive as easily without prostheses or modifications as the rest of us can with both hands. However those with bilateral above-elbow amputations generally need vehicle modifications.

  If you will need vehicle modifications, you should contact your state department of rehabilitation for information about available assistive devices and where they can be obtained. Also, don't forget to contact people with the same amputation as yours through your support group to see how they do it.

Conclusion

  A final word about your rehabilitation: All amputations are disabling to some degree, and some are quite a bit more disabling than others. But you have a life to live and you will want to get on with it, making it as enjoyable and productive as possible.

  You will find that it's frustrating at times and will probably be hard work. You might want to concentrate on what you have, rather than what you are missing. You might want to adopt the same philosophy many other people have, that you need to use everything you've got to make your life as normal as possible. This means using your prostheses when they allow you to do things more normally, using your residual limbs when that works better, using your feet when that's useful, and using as many adaptive devices as you can together with all the rest to make your life easier. One person, who has both an above-elbow amputation and a shoulder disarticulation, calls this, "a multi-media approach." She uses all these methods to live an amazingly normal life at home and at work. You can do it, too!

And some more information for the New Amputee

 For the New Amputee

A discussion of common feelings, concerns, and questions expressed by most amputees, as well as information about the surgery, recovery, and prosthesis (artificial limb)

 

Amputations occur for many reasons.

Trauma: motor vehicle accidents, work-related injuries

Diseases: poor circulation, diabetes, and cancer

Conditions present at birth

For whatever reason you may have had an amputation, our goal as health professionals is to help you regain your physical and emotional health. Because of continual advancements in prosthetic technology, most amputees can return to productive and independent lifestyles, doing many of the things they could do before their amputation. Your personal motivation and involvement with the rehabilitation process are essential ingredients for a successful recovery.

Preparation for Surgery:

If you and your physician have planned ahead for an amputation, here are some ways to help prepare yourself:

Meet the following individuals:

--A physical or occupational therapist, who can provide you with some strengthening exercises before surgery.

--A prosthetist (the professional who makes artificial limbs), who can answer questions related to your prosthesis.

--A fellow amputee, someone with a similar amputation who has returned to desired activities.

Your nurse or physician can help facilitate these learning opportunities for you. Please ask them for assistance if you are interested.

The Amputation-surgery--What's Important to Know?

Surgeons continue to improve the surgical techniques of amputation in order to create a residual limb that can function well with a prosthesis. Because of surgical and prosthetic advancements, an amputation is often considered part of a "reconstructive plan" to an improved lifestyle.

Your surgeon will always try to save as much of your limb as possible. The surgery itself usually takes only an hour or so. An incision is made through each layer of tissue--skin, muscle, blood vessels, nerves, and bone. For a closed amputation, a skin flap is used to cover the residual limb and then closed with sutures or staples.

In some instances, such as when the tissue has been infected prior to thesurgery, the surgeon may choose to perform an open amputation in which the skin flap is not closed immediately and the wound is left open and allowed to drain. Special dressing changes or other treatments (such as whirlpool or hyperbaric therapy) may be used to help clear up the infection and enable the tissue to heal from the inside out. The wound will be sutured closed at a later date, usually in one to three weeks. Healing takes longer for this type of amputation.

The residual limb's appearance after surgery will vary, depending upon the type of dressing your surgeon decides is best for you.

Most often, a soft dressing made of gauze bandages will cover and gently compress the residual limb. Your residual limb may be elevated to reduce swelling. You may have a drainage tube coming from the residual limb to eliminate excess bloody fluid from around the incision. The tube will be removed when the drainage is minimal, usually within a couple of days. When the first dressing is changed, elastic bandages may be used to wrap the residual limb. The sutures or staples are usually removed in two weeks. For people with poor circulation, they are removed in about three to four weeks.

Alternatively, you may have a rigid dressing (cast) over the residual limb to help decrease the swelling. A drainage tube coming through the cast may be present and will be removed when the drainage stops. The cast remains in place for about two weeks until the incision is well healed.

Sometimes, an Immediate Postoperative Prosthesis (IPOP) is created by attaching an aluminum tube and an artificial foot or hand to the cast. The amputee can then begin to practice walking or using the hand earlier, before the incision is completely healed.

The appearance of your residual limb after surgery may be difficult to accept at first. The obvious absence of the limb, along with the bulky dressing are painful reminders that your limb is permanently gone. "l'm not the same anymore!"

Touch and gently rub your residual limb--don't worry, you won't hurt it! This helps you become familiar with the feelings and sensations of this altered body part. Assist your physician or nurse with any necessary dressing changes or bandaging. It will help you gradually accept your residual limb as part of your own body.

Pain:

An amputation, like any surgical procedure, will cause postoperative pain. However, most people describe the amputation pain as being less than what they expected.

You may have a patient controlled analgesia machine (PCA) when you return to your room. This machine allows you to control the amount of pain medication you receive. If you don't have a PCA, other pain medicine will be available upon request from your nurse.

Phantom Sensations.

Nearly every amputee experiences the sensation that the amputated part is still present. You may have feelings of tingling, itching, or movement where your arm or leg used to be. Phantom sensations may occur immediately after surgery or any time thereafter. A variety of factors can stimulate these sensations--pressure applied to the residual limb, yawning, or even weather changes. Sometimes the sensation may feel like it is moving closer to the site of the amputation, and then soon disappear completely. While phantom sensations are different for everyone, they usually present no problems.

Phantom Pain.

In addition to phantom sensations, some people experience various types of pain in the missing limb. Phantom pain is often described as fleeting episodes of sharp, squeezing, burning, or "electric shock" sensations either within the residual limb or the missing limb.

While the causes of phantom pain are not clearly understood, some factors are thought to contribute to it--for instance, the presence of persistent pain in the affected limb prior to the amputation. Residual limb complications (like infection) and emotional distress may also trigger episodes of phantom pain.

Because phantom pain occurs unpredictably, it is important to let your physician or nurse know if you are experiencing it so that they can recommend ways to manage it. Gentle massages, certain medications, the application of warmth, or an electrical stimulation unit placed on the skin are among the methods used to help relieve phantom pain. Most occurrences of phantom pain disappear within a few weeks of surgery.

Common feelings after Surgery - An emotional whirlwind:

Having an amputation is difficult for anyone at any age. Losing a limb can threaten your feelings of self-worth and your physical capabilities. Most new amputees are filled with feelings and questions concerning:

Appearance: "What will I look like?" ...with or without the prosthesis.

Physical Abilities: "What will I be able to do?"

Social Acceptance: "What will other people think about me?"

Finances: "How can I afford all this?" ...related to the cost of health care, the prosthesis, and employment changes.

In addition to all these concerns, losing a limb creates a variety of grief responses. People experience feelings of numbness and disbelief--"I can't believe this is really happening to me!" Some feel anger and resentment- "Why ME?" Others feel extreme sadness over the loss and fear the uncertainty of their future. All of these emotions are normal responses to having an amputation. It is important for you and/or your family members to talk about these feelings and concerns with someone (your physician, nurse, social worker, or minister) who can help you sort through them.

Receiving detailed explanations and having your questions answered about the surgery and rehabilitation process will also enable you to regain a sense of emotional balance and begin your life as an amputee.

Activity after Surgery:

You will usually be assisted out of bed to a chair or recliner within the first day or two after surgery.

A physical or occupational therapist will assess your overall physical condition and prescribe an exercise pro- gram to help increase your muscle strength and flexibility. Isometric exercises, which practice tightening and relaxing muscles, will maintain good muscle tone. Active exercises will begin while you're still resting in bed. If you've had a lower limb amputation, your therapist will teach you how to walk with a walker or crutches once you are strong enough to bear your body weight.

Proper body positioning while resting is also an essential part of your exercise program because it helps prevent muscle and joint contractures (tightening). Contractures may hinder successful use of a prosthesis.

Remember--your cooperation and participation in your exercise program is essential in preparing you to successfully use your prosthesis and return to desired activities.

 

Preparing for the prothesis:

After the initial adjustment to the amputation, you will begin to focus your attention on obtaining the prosthesis and resuming physical activity. Generally, the earlier a prosthes is fitted and worn, the better it is for the amputee--both physically and emotionally. Your health care professionals plan your care with this goal in mind.

You can help prepare yourself for the prosthetic fitting in two ways. First, by wholeheartedly participating in your exercise program, you will increase your overall strength, as well as the specific muscles needed to effectively use a prosthesis.

Secondly, reducing the swelling of the residual limb is essential for prosthetic fitting and use. Wrapping with elastic bandages or using elastic "shrinkers" will decrease the swelling and help shape the residual limb. If wrapping or a shrinker is prescribed for you, your physical therapist and nurse will teach you and/or a family member how to do this at the appropriate time. It is important that you keep your residual limb properly wrapped or within the shrinker at all times--not only before your fitting, but also when you are not wearing your prosthesis.

 

All abouth the prothesis:

Time of Fitting:

Your surgeon and prosthetist plan for you to obtain the prosthesis as soon as possible. Once your residual limb is well healed, nontender, and has minimal swelling, you can be measured for the prosthesis. The first fitting is usually about four to five weeks after the amputation, if there have been no complications. For people with poor circulation, the fitting is often delayed another two to three weeks to ensure adequate healing. Within a week or two after the fitting, your initial prosthesis (often called the "preparatory" or "temporary") will be available to begin your training.

The Prosthetic Prescription:

The goal of the prosthetist is to provide amputees with a prosthesis that will help them return to their place in society, participating in the activities that are important to them. The prosthesis is designed to be as comfortable as possible, while providing maximum mobility, and a satisfying appearance. Many individual factors are considered in prescribing which type of prosthesis an amputee should receive: The shape and condition of the residual limb Overall physical and mental condition Previous activity level and lifestyle Age Available funding A variety of prosthetic feet, knees, elbows, and hands are available--each with specific functional features designed to meet individual needs. Your communication with your prosthetist regarding your activity goals is very important in order to create a prosthesis best suited for you.

How the prosthesis is made:

The prosthetist first takes a series of measurements of your residual limb and then makes a cast mold of it, so that a custom socket can be made. The socket is then attached to the other components (hand, foot, knee, etc.) and many alignment adjustments are made. A variety of advanced technology materials--such as carbon, graphite, aluminum alloys, and various plastics are used to make the prosthesis. These materials provide greater strength, less weight, and an improved appearance.

The prosthesis is held on in a variety of ways--either by straps, clips, foam inserts, or suction. It is eventually formed to resemble your opposite limb as closely as possible. Prosthetic fitting and alignment are specialized procedures that require expert skills from the prosthetist, as well as a great deal of patience and cooperation from the amputee.

Training:

During the initial fitting trials, the prosthetist will guide you in the basic principles of using the prosthesis, fine tuning the fit and alignment as needed.

Extensive training for lower limb amputees will be provided by a physical therapist. This includes managing daily activities like bathing, walking on different terrains, stair climbing, and getting in and out of an automobile. Those with an upper limb prosthesis will be trained by an occupational therapist to perform daily activities such as grooming, eating, and handling various objects.

You may undergo your training as an inpatient (within a rehabilitation unit) or on an outpatient basis. You and your physician can decide which rehabilitation plan is best for you.

Payement for the prothesis:

Because prostheses are custom designed devices made of advanced materials, they may be very expensive. Insurance coverage for prosthetics varies widely, but most private insurance plans will pay 80% of the charges. Medicare pays a portion of the charges for eligible beneficiaries as well. If your insurance policy will not cover the cost--or if you don't have insurance--there are governmental agencies like Vocational Rehabilitation that may provide funding for the prosthesis. Local organizations like Easter Seals may also be able to help. Social workers or personnel within the prosthetic office can advise you how to best manage the cost of the prosthesis. Please ask if you need assistance.

Feelings of New prosthetic wearers:

Most new prosthetic wearers have mixed emotions of excitement--in beginning their return to desired activities-- and frustration in having to adjust to the unnatural feeling of a mechanical limb.

Using a prosthesis requires a great deal of patience from new amputees-- they must learn how to walk or use their hands all over again.

When initially returning to the home environment, and beginning to practice with the prosthesis, the full impact of having lost a limb often becomes more evident to the amputee--rekindling feelings of sadness and discouragement.

While training to use the prosthesis, it is important to focus on the daily accomplishments and successes achieved with the new limb in order to minimize these feelings of frustration. Soon, most amputees are encouraged to discover how much they can do with their prosthesis.

Some amputees recall their initial feeling of using a prosthesis:

"It was all positive for me. I went from having no hand to having something that worked. It was like having a challenging toy to play with--I worked hard at it until I was good" (A 25 year-old below elbow amputee)

"I felt like I always needed more patience with myself when learning how to use my leg. It was hard not being able to keep up my old pace. My husband was very supportive in helping me adjust to the changes" (A 62 year-old above knee amputee)

"It seemed pretty natural to just start walking again. I never had any major problems doing what I wanted to do" (A 40 year-old below knee amputee)

"The cosmetic appearance probably bothered me the most at first--it just didn't look like my leg. I didn't want any help from people--even when I'd fall... I wanted to do it all on my own. I got frustrated with all the adjustments that had to be made" (A 35 year-old above knee amputee)

Commonly asked questions:

We encourage you to ask questions. The more you know about your prosthesis and rehabilitation process, the better prepared you will be to help yourself "get back on your feet again."

Q. How long will it take me to use my prosthesis successfully and return to specific activities?

The pace of rehabilitation is different for every amputee-- depending on overall physical health, muscular strength, and personal motivation. Generally, within a few weeks after beginning prosthetic training, you should be able to accomplish most of your routine daily activities.

Q. I've seen people on TV who play sports and climb mountains with a prosthesis. Will I be able to do that?

What you can do is determined by your physical condition as well as your prosthesis. The initial prosthesis (often called a "preparatory") is usually designed only for basic activities. But be sure to discuss your interests in work, recreation, or sports activities with your prosthetist. Once you have mastered the initial prosthesis, a more complex "definitive" type can be created. If you were involved in sports before you amputation, most likely you'll be able to continue participating in various activities such as golf, basketball, bowling, biking, tennis, swimming, skiing, etc. Discuss your goals with your prosthetist, who will offer a prosthetic design to assist you in your endeavors. He or she can also provide you with information about various national associations that support these sports activities.

Q. Will I be able to return to work?

Many amputees can return to their current jobs without any problems. Others may need to alter their duties within their profession or change jobs completely. It is important to talk with your employer about your desires and capabilities. If job alterations or changes are required, your local Vocational Rehabilitation representative can assist you in returning to the work force. If your amputation and related health problems have disabled you to an extent that future employment is not possible, you may be eligible for disability-related benefits from the Social Security Administration.

Q. Will I be able to drive a car?

Driving presents minimal problems for most amputees. Depending on the type of amputation, you may require an adaptive device for your car. Leg amputees may choose to install a left foot gas pedal or hand controls. Arm amputees often require automatic transmission, power steering, and modifications to control the shift lever. You should contact your local Motor Vehicle Administration office in case they require you to take a recertification exam. They can also advise you on your best options for adaptive devices.

Q. Can I get my prosthesis wet? Can I swim with it?

Your prosthesis is not designed to get excessively wet -- water may damage the various components. (Getting caught in the rain for a few minutes will not hurt it). If you want to use your prosthesis for water activities like swimming, scuba diving, or beach fun, discuss this with your prosthetist. You may prefer a specialized prosthesis with water resistant components.

Q. What kind of shoes can I wear with my prosthesis?

Most prosthetic feet are designed with a 3/4 inch heel height, which allows you to wear most casual shoe styles, work shoes, or low heeled dress shoes. Your shoes should be comfortable, fit the prosthetic foot snugly, and have non- slippery soles. You have the option of choosing various feet with differing heel heights and should discuss your preference with your prosthetist.

Q. How do I choose the right prosthetist?

Three factors are important in choosing a prosthetist:

1) Certification: Your prosthetist should be credentialed by the American Board for Certification in Prosthetics and Orthotics, Inc. This ensures competency in his or her knowledge base and technical skills. The title of Certified Prosthetist-Orthotist (C.P.O.) or Certified Prosthetist (C.P.) is granted to qualified practitioners by the A.B.C..

2) Communication: You should feel comfortable talking with your prosthetist about your needs, concerns, and goals. Remember, his or her purpose is to assist you in returning to your desired activities with maximal comfort. If open, honest communication does not exist--successful prosthetic use will be hindered.

3) Location: If possible, you should choose a certified prosthetist located relatively close to your home, so that periodic evaluations and prosthetic adjustments will not create a hardship for you and/or your family. The temptation to delay or avoid prosthetic appointments because of long distance travel might lead to unwanted complications.

Q. How often will I have to see my prosthetist?

During the initial fitting and training period, you will probably see your prosthetist several times. Follow-up appointments may then occur every three to six months to evaluate your progress. After receiving your definitive (or "permanent") prosthesis, you might see your prosthetist only as changes or problems occur.

Q. How long will my prosthesis last? Will I ever need another one?

Your definitive prosthesis can last for many years, provided you take proper care of it and have it periodically "checked and serviced" by your prosthetist. Weight gains and losses significantly affect the prosthetic fitting, requiring adjustments or even a new prosthesis. If your prosthesis causes you pain, skin irritation, or redness that does not go away, contact your physician or prosthetist. They will recommend adjustments or that a new prosthesis be made for you if the present fitting, function, and comfort are not adequate.

Q. How should I deal with people who stare at me or ask me questions about my missing limb?

First of all, remember that most people (including yourself) will look a second or third time at any person who looks "different" for any reason. The additional glance is usually one of curiosity--not one of pity or "making fun." The same motive exists for people who question you about your amputation or prosthesis--generally, they are just curious. Provide honest answers about why you lost your limb, etc.; people will learn from you. You 're the expert with something to share! As you offer explanations and answers, both friends and strangers will adapt more quickly to your changes and feel more at ease around you.

Q. Will being an amputee affect my sexual activity?

New amputees are initially very concerned about their body appearance, sometimes fearing that they may not be found attractive or accepted by their spouse or partner. Most say that, with the passage of time, they successfully overcame any feelings of being sexually inadequate. Receiving support and reassurance from the partner, as well as from other amputees, will greatly help in this adjustment.

Q. Are there any organizations for amputees that might he helpful to me and my family?

Many amputee support groups exist across the country that can provide you and your family with the opportunity to meet other amputees and learn from their experiences. You can also receive pertinent information related to amputee or prosthetic issues. There are national organizations that support and promote amputee participation in various sports like skiing, golf, and even the Olympics. Your nurse or prosthetist can provide you with the information about these groups.

For more information:

A Manual For Above-Knee Amputees, Alvin C. Muilenburg, C.P.O. and A. Bennett Wilson, Jr., 28 pages.

A Manual For Below-Knee Amputees, Alvin C. Muilenburg, C.P.O. and A. Bennett Wilson, Jr., 20 pages. Limb Prosthetics, A. Bennett Wilson, Jr., 122 pages.

Available from: American Academy of Orthotists and Prosthetists 1650 King Street, Fifth Floor Alexandria, VA 22314

Amputee's Guide - AK, Anne Alexander, R.P.T., 21 pages.

Amputee's Guide - BK Anne Alexander, R.P.T., 19 pages. Crutches on the Go, Murray A. Swanson, 21 pages.

Available from: Medic Publishing Co. P.O. Box 89 Redmond, WA 98073-0089

Children With Limb Loss - A Handbook for Families - Ages birth to five years, Revised Edition, 32 pages. Children With Limb Loss - A Handbook for Families - Ages six to twelve years, Revised Edition, 32 pages. Adolescents With Limb Loss - A Handbook for Adolescents and Their Families, Revised Edition, 39 pages.

Available from: Area Child Amputee Center Mary Free Bed Hospital & Rehabilitation Center 235 Wealthy SE Grand Rapids, MI 49503
 

More New Amputee information and tips can be found here:
http://home.comcast.net/~n2fc/natamp/tips.html
http://amputee-support.med.nyu.edu/new-amputee
http://www.prostheticdesigners.com/amputee.htm
http://www.amputee-coalition.org/fact_sheets/prosfaq.html
http://www.cornelloandp.com/prothetics/new-amputees-instructions/
http://coastingtogether.wordpress.com/services/useful-information-for-new-amputees/