Amputee Treatment Center Forum

GENERAL CATEGORY => General Discussion => Topic started by: gypse on February 21, 2008, 02:01:36 AM

Title: New amputation questions
Post by: gypse on February 21, 2008, 02:01:36 AM
My father had a left bka 11 days ago as a result of a work injury 20 plus years ago. The last two years he has had multiple surgeries in an attempt to save his leg. The leg has been severly infected for nearly two years. The amputation was actually done two weeks ago and left open to drain. Four days later the surgeon found more bacterail growth on the bone and amputated an inch or so more then sealed the site. He is in severe pain (he is vomiting because the pain is so bad) and losing feeling in the limb is this normal? If so how long does it last? How long does the swelling last? His doctor is of no help with any questions no one can get a straight answer from him about anything.I think its noteworthy to mention that he quit smoking two weeks ago. Sorry for so many questions but this is new to us. Thanks.
Title: Re: New amputation questions
Post by: Dick Stevens on February 21, 2008, 02:55:34 AM
Hi, Gypse:

Welcome aboard.  Sorry to hear that you and your dad qualify to be here, but since you do, I hope we can be of some help.

First of all, everyone's situation is unique, so there's no one "normal" healing time or schedule of milestones.  Since the amputation was complicated by a second cut on the bone, your dad has already been thru a double-whammy. 

I do know that any bone infection can be extremely painful.  Add that to the normal post-operative healing, and your dad is one mighty sore puppy, right?   Add to that the fact that he quit smoking in the midst of all this, and his discomfort may be heightened even omre.

You may want a joint consult with the surgeon AND a pain management specialist.  And he'll want to monitor very closely that ALL of the bone infection is gone.  Then to give the jangled nerves time to settle down.

It helps if you, or someone dad knows and trusts, can be with him for the consults, so the docs can see a united family supporting him.  And if he is the least bit fuzzy-headed because of the pain and/or medications, you can hear what's being said and ask the apporpriate questions.

Wishing you both the very best.  Please keep us posted how it goes.  Hopefully the pain will soon ease up.

Dick Stevens, DBKA in PA
Title: Re: New amputation questions
Post by: JClark on February 21, 2008, 08:32:31 AM
I agree with one thing Dick said, you need to have someone go with your dad to the doctor to make sure questions are asked and answered.  It really scares the doc to write down what is said and have your questions written down ahead of time.  It shows the doc you are serious, and makes sure you don't forget anything.

I would go for a joint consult or if that's not possible, go for a second opinion.  Check out a pain specialist.  Go to an ORTHOPEDIC surgeon.  You didn't say what kind of doc did the amputation, but ortho docs know bones and related pain better than say a vascular doc.  Check out an infectious disease doc too.

Questions I would ask:
Is there an infection?  What tests have been done to prove this?  What medications are being used to fight or prevent infection?

Is there a nerve impingement/pinch causing the numbness?

What medications are being used to treat the pain?  What other medications can the doctor suggest to help with pain?

Is a drug like Neurontin, Lyrica or a medication similar to these something the doctor would be willing to try for pain relief?

But seriously - GET TO a DIFFERENT doctor for a second opinion.  Go in with a WRITTEN list of questions and TAKE NOTES.  Ask questions until you understand the answers. 

The only doctor who ever treated me like an idiot when I pulled out my questions and took notes was not a good doctor.  My 2nd opinion was his "buddy" he referred me to and he was pissed about the care I'd gotten, he told me so.  I switched doctors immediately.

The pain your father is going through MIGHT be normal FOR HIM.  But the only way to know is to check it out.

Please let us know how things turn out.  Feel free to ask us questions.  We're not doctors.  But for myself, I've spent enough time in exam rooms and operating rooms, I know they're just people and sometimes they act like humans.

Good luck.

Title: Re: New amputation questions
Post by: ginger on February 21, 2008, 08:54:33 AM
I unfortunitly also had to have an above knee amp due to an infection 7 months ago.  I had severe pain for about 2 weeks post op, but it was no worse than all the preop pain due to the inection.  I also had my surgeons leave the incision open and then a couple days late go back and make sure the infection was gone.  After all my surgerie(16) in the last 5 years, I guess one moe was no big deal.  Make sure that your father is telling EVERYONE that he is in pain.  The doctors, the nurses, and anyone else that comes into his room.  Here in New York, pain is now considered one of the vital signs, like temp, B/P, breathing rate.  If He id in that much pain, everyone needs to know and if nothing is being done about it, go to the management of the hospital.  Start with the head nurse or nurse manager of the floor and work your way up the management ladder.  Everyone has a boss.
As for his recovery, he can and will have his up and down days.  Make sure that he gets a reputable prosthetitist.  The better his prosthetic, the better he will accept his amputation.
Good luck and keep in touch.   
Title: Re: New amputation questions
Post by: Mitchee on February 21, 2008, 04:58:09 PM
Hello.  I am an LBKA for 14 months.  I suffered from numerous infections including antibiotic resistant staph and osteomyelitis prior to amputation.  I was on IV antibiotics for several months at a time.  (I chose to amputate my leg due to chronic pain.  It was not infected at the time of amputation.)  I had multiple surgeries in an attempt to reconstruct my left ankle.  When I suffered from infections, I knew that something wasn't right.  I didn't feel like I did after all of my other surgeries.  The pain was different.  I knew something was wrong.  My surgeon knew that I thought something was wrong so he was proactive in my care.  Unfortunately, not all surgeons are in tune with their patients.  Pain and recovery are different for everyone but if you think that something is wrong, it probably is!  You know your body better than anyone else.    Ask for a second opinion if you do not like the doctor's answers of if they are too vague.  Don't be afraid to ask to see another doctor.  If you don't look out for your health, no one else will.  I would also ask for a bone scan of the residual limb.  If they won't do a bone scan I would push for an MRI and a CT.  This would also provide a baseline for comparison of any scans that you might have done in the future.  The nausea and vomiting might be caused from any antibiotics that you may be taking.  Mention it to the doctor, he should be able to give you something to help with the nausea. 

Please remember that most of us are not physicians (including me).  The info that we provide comes from our experiences and should always be discussed with a physician before implementing any of our recommendations.

Good luck and please update us on how everything is going.     
Title: Re: New amputation questions
Post by: ginger on February 21, 2008, 05:41:28 PM
How right you are about talking to your doctor first.  I know what you mean by suffering from infections and being on several runs of antibiotics.  I had 4 Knee replacements that all got infected before my amputation.  I also had CT scans and MRI's, even the 3 bone scans weren't showing the infection. I wound up with VRE (vancomyacin resistant enterococcus) in my tibia.  And I knew that something wasn't right just like you, thank goodness my surgeon listened and sent me to a large teaching hospital for a consult. 
Hope that all is going well with you now.
keep in touch
Title: Re: New amputation questions
Post by: gypse on February 22, 2008, 01:20:57 AM
Thank you all so much for your help. My mom goes with him to his appointments . It was an ortho surgeon who performed the surgery. However, the surgeon does not even see him in the office. It was the PA in the office today who removed the bandage (and it will be the PA the next three appointments not the doc). The sutures could not be removed today because the site is red according to the PA. The anti-seizure drugs is what I was thinking too, but the PA said no this was phantom pain.Yet, my dad says the pain is at the stump. I can't remember the name of the pain medication I know it starts with an N and its compatible to Vicodin (am told by my mom). MRSA was found in the surgical pins and rods after the numerous attempts to save the leg. He was on Vanco via picc line for several months (monitored by an infection control doctor). When he developed a blood clot the picc line was dc'd and none were given until last week. He does see the infection control doc in one week. Health care is terrible here I can say that as a patient, family member of a patient and spending half of my life working in healthcare. The sad/scary part is both doctors really are the best. I am also kind of shocked that the surgeon says PT won't be necessary???  Maybe I am just to organized. I know I want the A to Z of a treatment plan laid out, and the doc is just taking it one thing at a time. I really do appreciate your help. I'm sorry for being so wordy and full of questions. I love my dad and I am pretty protective maybe over protective.
Title: Re: New amputation questions
Post by: Dick Stevens on February 22, 2008, 03:11:53 AM

If I had as much trouble as your dad is having, and the doc leaves it to a PA for 4 appointments in a row, I'd be hunting for a new doc.  PA's may be great. But as the name suggests, they should be ASSISTING the doc, not replacing him.

Your dad and/or his insurance co. are paying for a DOCTOR's care, insist on it.

I hope your dad gets relief soon.

Title: Re: New amputation questions
Post by: allen-uk on February 23, 2008, 06:30:34 AM

PT (physiotherapy here in the UK) is ALWAYS necessary after any major operation, and after amputation, as necessary as breathing.

Even if they think your dad will never walk again, he must get his residual muscles back working in some way, otherwise he won't even be able to use a wheelchair.

If you have such people in the US, try and see a consultant physiotherapist, or at least some sort of top manager, as from my experience doctors and even high-up consultants are often quite ignorant of what physiotherapy is, and does, and in the UK often see it as a last resort - a place you send patients to, if you've run out of options. And you're right, it ISN'T that at all. It's a vital step in rehabilitation.

Keep on fighting. Your dad is lucky to have you punching for him.

Allen, bka, London.