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amputation after paraplegia

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  • #16
    We used to respond to orthopedists who just wanted to amputate "because you aren't using your legs anyway" by saying "so should we cut your head off at the neck since it doesn't appear you are using your brain!".

    An AK amputation will definitely effect your sitting posture, balance and cushion needs. Your posterior thighs should be off-loading your ischiums if you are properly fit with your cushion, and if you have less thigh, you have less ability to do that. This is aside from the cosmetic issue of an amputation (or two), and people with paralysis are not usually candidates for prosthetic legs, even cosmetic ones. Yes, you will weigh less (duh!) and it may be easier to transfer, but the trade off with significantly more risk for pressure (sores) injuries needs to be considered as part of the decision.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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    • #17
      Originally posted by paraparajumper View Post
      The whole "legs serve a pivot point for balance" and are absolutely necessary for safe and productive transfers argument is so overused and spoken as truth in the SCI community, I find it ridiculous. Of course, you hear that by individuals with legs, because they don't know any different. Positioning of your hands and upper body strength is far more important. You have greater transfer range and distance abilities without the legs. All my transfers have been cleaner and safer, and with less episodes of shearing.

      Both my legs were amputated AK over 2 years ago now, was the best decision I made post injury. If you're adept with upper body coordination, your transfers will become easier. It'll take a week or two to get used to weight distribution, but everything about ridding yourself that dead, lifeless weight is a benefit.

      Less cumbersome transfers, faster transfers, quicker movement when out of your chair, no repositioning of your legs, easier to get closer to objects and roll straight up to things, etc, etc, etc Would do more harm then good? Hardly.

      The only 'negative' is losing a lap to balance objects on. I just have to get more creative now with how I carry things.

      I can see it being difficult to wrap your head around after 55 years post. I waited 4 and wish it was done right away. If you find the few other SCI here who have had their legs cut off, every single one says the same thing I have.
      thanks for the helpful prospective, PJ. As usual in CC there are two or more answers to any question because the context of our lives & injuries are different. As in this case, where I've had to weigh all the anecdotes (including mine) against each other & against clinical and research data. Comorbidities, age, past lifestyle and future expectations have all to be taken into account. - fw

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      • #18
        Damn, I just noticed the error in the heading of my update. The fracture was femoral, not tibial. A thousand apologies to anyone this has led astray! fw


        Originally posted by firewheels View Post
        Jun 6th '18 (6 weeks later): Thanks to my daughters and a PA here at the rehab, I've gotten new x-rays and a consultation with the Chief of orthopedic trauma surgery at BWH in Boston. The fracture is still complete but apparently more stable.

        Contrary to the advice given by his Fellow, the Chief agrees that given my particular situation, amputation would do me more harm than good. The fracture is right above the femoral condyles & I'm supposed to flex the leg on the break rather than on the knee itself. We've tried this and it seems to work, the job right now is to reestablish safe transfers between bed and wheelchair. It's going to be an interesting process.

        I've been very lucky to work with this crew of surgeons. They know everything about leg trauma in ABs but nothing about handling it in paras, and were very appreciative of my helping them to educate themselves about that. The process is collaborative for once and even if I can't manage the rehabilitation, all concerned are learning things.

        My review of posts relating to leg trauma in CareCure was invaluable in getting me up to speed about talking to clinicians about leg trauma and SCI. My thanks to all those posters! - fw
        Last edited by firewheels; 06-11-2018, 03:47 AM. Reason: typos, typos. Damned difficult writing on an iPhone.

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        • #19
          Last edited by firewheels; 06-11-2018, 04:23 AM. Reason: Mistake, can't kill. Please ignore.

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          • #20
            Firewheels, I see you are from MA. Get a second opinion from Dr. Malcomb Smith at MGH Orthopedic Trauma Center. He is a little hard to understand as he speaks with a heavy UK accent. Pretty sure he is British but he sounds Scottish, lol. Funny guy, nice guy, straight shooter.

            https://www.massgeneral.org/doctors/...aspx?id=17426#

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            • #21
              Originally posted by smokey View Post
              Firewheels, I see you are from MA. Get a second opinion from Dr. Malcomb Smith at MGH Orthopedic Trauma Center. He is a little hard to understand as he speaks with a heavy UK accent. Pretty sure he is British but he sounds Scottish, lol. Funny guy, nice guy, straight shooter.
              z
              Thanks, smokey. I wouldn't be surprised if Dr. Malcolm knows Dr Weaver, the orthopedic trauma chief at BWH. Weaver's told me that living with the broken leg (no surgery) is now the preferred procedure. It's been super hard to reestablish my transfers, but I'm hoping to be out of rehab and on my way back to reasonable independence by mid-August.

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              • #22
                Seven months ago I had my right leg amputated at the knee because we found that healing the wounds on my right ankle were proving impossible!
                I wish Had accepted that a few years earlier
                It has been a net plus with a learning curve.
                See linked conversation:
                69yo male T12 complete since 1995
                NW NJ

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                • #23
                  IMO, 55 post, you've had a pretty good run and now you had some serious injuries which could still yet cost you your life. I would say count your blessings, make your life infinitely easier and safer, not to mention easing the burden on others, whether paid or unpaid, and get yourself an overhead lift.

                  You won't have to worry about altered transfer techniques, loss of balance, risk of falling, etc. After all, at this point, what are you trying to prove? And, it's just not the transfer that puts you at risk for future injury, it's the subsequent maneuvers to get your legs into bed and then get yourself situated where you want to in bed. Sometimes the most innocuous maneuvers can place strange vectors of force on weakened bones, especially those with internal fixation, and result in fracture. Happens all the time, even in those younger than you and with no previous history of fracture.

                  You will have to be extremely careful for the rest of your life.
                   

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