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Diabetes and Amputations Part 2

How does having an amputation impact on my life?

It is a significant loss; losing your limb may seem like a life sentence, the end of the world…but it isn’t! Losing a limb or limbs will affect people in different ways.  The emotional loss can be like losing a relative and it will take time to adapt to it. Physically, your body will be permanently altered, and it can impact all areas of your life.  Nonetheless, there are virtually no activities that a person with an amputation cannot perform with the right help, training and equipment. The extent of your physical recovery will determine to some degree the actual changes in your life.

Last week I received e-mails from two persons regarding possible amputations. In both instances, the parties involved, as stated by their relatives, are adamant that they prefer die than to lose a limb. It’s a sad day!

Why do patients need to undergo amputations?

The vast majority of amputations are performed because the arteries of the legs have become blocked due to hardening (atherosclerosis).  Blockages result in insufficient blood supply to the limb.  Because diabetes can cause hardening, about 30-40% of amputations are performed on patients with diabetes.  Patients with diabetes can develop toe/foot ulcerations, and about 7% of them will have an active or healed ulcer.  Ulcers are recurrent in many cases, and approximately 5-15% of diabetic patients with ulcers will ultimately require an amputation.  Because hardening of the arteries occurs most commonly in persons who smoke, the majority of amputations for vascular disease occur in this group. Diabetes, however, may be an important factor in nearly 40% of persons undergoing major amputations.

When hardening of the arteries becomes so severe that gangrene develops or pain becomes constant and severe, amputation may be the only option.  If amputation is not performed in these circumstances, infection can develop and threaten the life of the patient. Sometimes bypass surgery can be performed to avoid amputation, but not all patients are suitable for bypass surgery.

Complications of amputation surgery

  • Risk of dying
  • Chest infections
  • Angina
  • Heart attack
  • Stroke
  • Pressure/bed sores – regular turning to relieve pressure could prevent/help alleviate this problem.
  • Wound infections – antibiotics are usually given to reduce this risk. The infection generally occurs as a result of a fall, or more commonly poor circulation. Infections sometimes lead to further surgery, whereby more of the limb is removed.
  • Deep venous thrombosis can also occur, because the veins in the leg would have been tied during the amputation operation, and because of the immobility after the surgery.  Blood thinners are usually given to reduce the risk of blood clots developing.

Phantom Pains

Phantom limb pain is the sensation of still being able to feel the amputated limb.  Many amputees experience this sensation, although the intensity can vary from person to person. Strictly speaking, it is difficult to treat; taking pain killers is the method used to hopefully help achieve some measure of relief.

Is walking possible?

Whether or not a patient will be able to walk following an amputation has been studied by looking at factors present before surgery. Poor pre-operative mobility, being over 70 years, dementia, severe kidney and heart disease, are factors which lessen the likelihood of walking after amputation.

For instance, it is generally easier to walk with an artificial leg (prosthesis) after a below knee amputation.  If you were able to walk normally before your amputation and do not have other illnesses such as angina or breathing difficulties, it’s more likely you will walk after your amputation.

Some studies have shown that in elderly patients undergoing major amputation (below or above knee) for hardening of the arteries, over half the patients fitted with an artificial leg never used it effectively. This is especially so if rehabilitation was delayed for longer than two months after the amputation.  It can take between 6 and 12 months for full rehabilitation potential to be reached. Most patients undergoing minor amputation will be able to walk virtually normally after surgery.

Life after an amputation

Initially there will be a period of recovery from the operation.  Once that recovery has taken place, physiotherapists and occupational therapists will concentrate on enabling you to manage independently.  This will require learning new skills, such as moving from a wheelchair to the bed and back again, using a wheelchair, and starting to use an artificial limb.  There will be various exercises to strengthen the upper body, and maintain flexibility and movement in the amputated leg.

If you are well enough, it may be possible to walk on a temporary artificial leg very soon after your operation.  This prosthesis has an inflatable section which is placed around the newly formed stump.  This can be a very successful method of early rehabilitation; but a permanent made-to-measure artificial leg will be made for you after referral and assessment.  However, it can only be done when your leg swelling is getting better, and may take more than one attempt before the right fit is obtained.

After an amputation the majority of patients need the help of a wheelchair to remain mobile.  Sometimes the use of a wheelchair may actually be the best way of remaining mobile.  If you are very elderly, or have had other serious illnesses such as heart disease or stroke, then it’s more frequently better not to be fitted with an artificial leg.

Your feet mirror your general health . . . cherish them!

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