Amputation—Advice From a Physical Therapist

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In view of blogger Jan Chait’s recent surgery — a below-the-knee-amputation of her left leg — I thought I’d talk to some experts on this topic to see if I could round up some information and advice for Jan to guide her in the days ahead. I first talked to Amber Fitzsimmons, a physical therapist and mobility adviser for BraunAbility, a company that remanufactures minivans to make them accessible to wheelchairs and scooters.

Amber had lots of tips for the healthiest possible recuperation, including these key points:

• Gather and use your health-care team

• Set some specific goals for your recovery

• Attend to pain early

• Get help stopping smoking if you smoke

Gather and use your health-care team
Recovering and regaining mobility after an amputation takes a lot of work in many different areas. That’s why having a recovery team with a variety of specialists is the best approach. What follows is not a comprehensive list of everyone who might be involved in a person’s care after the surgery, but it describes some of the key players:

• Physical therapist (PT) and occupational therapist (OT). The PT and the OT work together to help a person regain mobility. Typically, they start working with a person in the hospital and continue after the person is discharged, either to home or to a rehabilitation center. The work of the PT and OT includes teaching the person exercises to strengthen the muscles needed to support the body during movement, “transfer” training (teaching the person how to get safely from bed to wheelchair to toilet, etc.), and teaching a person to use mobility equipment. It may also include a home safety evaluation and recommendations for home modifications, such as the installation of grab bars.

• Nutritionist or dietitian. According to Amber, the value of good nutrition after an amputation cannot be underestimated. Adequate protein, in particular, is needed to promote wound healing. And of course, good nutrition is important for managing blood glucose levels, as well. Even a person who normally does well with meal planning for diabetes would benefit from meeting with a nutritionist after an amputation to discuss special or changing nutrition needs.

• Psychotherapist, support group, supportive friends and family members. Getting social, emotional, and practical support following an amputation is also critical. Of course, Jan knows she can always call her supporters here at Diabetes Self-Management, but she might also want to check out the National Peer Network of the Amputee Coalition of America to connect with people who are facing similar challenges.

• Physiatrist. Pronounced “phiz ī’ a trist” (with the accent on the long “i”), a physiatrist is a rehab doctor who specializes in long-term disability medicine, including pain associated with amputation, such as phantom limb pain. (To read more about this specialty, go to the Web site of the American Academy of Physical Medicine and Rehabilitation.) According to Amber, this is the person to turn to if phantom pain — or other types of pain — become an issue.

Set some specific goals for your recovery
For some people, walking may be a primary goal after amputation, while for others it may not. Whichever the case, it’s important to set some goals to work toward after an amputation, such as attending a special event that’s coming up or being able to perform certain activities around the house.

Attend to pain early
The earlier you get help for pain the better, and probably the best person to turn to for post-amputation pain is a physiatrist.

Get help stopping smoking if you smoke
Smoking is one of the worst things you can do to promote wound healing. Even occasional smoking delays wounds healing, so anyone who smokes would do well to seek help for stopping.

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