Archive for March, 2011
Look around you when out in public. I find there are more amputees out and about, or maybe I am more aware of this population after I was told I would be one if I didn’t have the surgery. I am so impressed with those I have met that choose to lead very normal lives, even those that are wheel chair bound.
While heading to the grocery store from the parking lot, a tall slender man walked quickly past me. When I looked down I was surprised to see he was a double amputee. You would not have known if he hadn’t had shorts on. While at the acupuncturist with my husband, a young girl in her 20′s literally came running down the long stairs. She, too, was a amputee. I stopped her to find out what had happened. She told me she was in a shipyard accident and her leg was crushed and couldn’t be saved. She was very positive and was planning on running in a marathon this summer. I have seen children who probably adapt better than any of us.
To me attitude is everything. Bonnie is one of those people. She is positive, a role model for others and is busy in her community. Sure she could have stayed home and felt sorry for herself, but she didn’t. That’s why I want you to hear her story. If you are following her story, you know she has had more that her fair share of set backs during this discovery of Charcot, amputation and hospital stay. She was merely told if they couldn’t save the foot they would amputate during surgery.
I wondered how I would take the news. I know my surgeon told me he would make sure his patient understood the consequences and expectations. In doing research on amputation, I often find researchers say that if a part of our body is lost, amputated, we experience the grieving process much like death. Dr. Elizabeth Kubler-Ross in her book on Death and Dying outlines five stages of the grieving process. Omal Bani Saberi, LCSW, CCHT has put these in context of limb loss as follows.
1. Denial and Isolation. “This is impossible. It’s not really happening! I feel nothing at all.”
2. Anger. ‘Why is this happening to me? I’m enraged! God is unjust.”
3. Bargaining. “If I promise to do such and such, maybe I’ll get my old life back.”
4. Depression. “I feel hopeless. Everything is beyond my control. Why bother trying? I give up.”
5. Acceptance. “I don’t like it, but the amputation is a reality. I’ll find ways to make the best of it and go on.”
Many factors including those prior to the event. How well do, or did you handle problems? Your support group of family , or friends, cultural values and norms and of course socioeconomic factors.
Bonnie had so many things going on, I think she went quickly to step 5. I am sure she spent only a short time on the other four.
Remember there are 225 amputations of diabetic feet or legs each day in the USA.
Bonnie commented on the dark days of Alaska in the fall and winter while she was trying to heal her Charcot Foot. Later she talks of not remembering some things and how depressed she was. She really enjoyed the sun. Both of us having grown up in Nebraska, I could understand her feelings. In looking back on my recovery from Charcot Foot surgery, we chose to have the surgery during the summer as I felt that was better for me. Bonnie, as well as, many others have no choice. Many of our friends felt we would be better off having the surgery during the fall. With recovery during fall and winter because you can’t do a lot because of the weather. I wasn’t thinking about depression, but the fact that the weather would be warmer. We could leave doors to my studio open if I wanted. I didn’t have to think about Max driving to doctors appointments on icy roads, or my being pushed in a wheel chair either. I just knew I would be happier being able to look outside and be able to go out doors if I wanted.
Mid February, I discovered an article on depression in the Star-Herald from Scottsbluff, NE written by Nicole Vidlak, a licensed clinical psychologist and contributing writer. Her focus was primarily on heart disease. She referenced Johns Hopkins University in Baltimore, MD. She listed nine physical effects which I have blocked out here for you to read.
It was mentioned that individuals who are depressed may have difficulty taking some medications they need for their treatment. It seems Chronically-elevated levels of stress hormones common in depression can have negative effects. One who seeks mental health treatment for depression can make a positive impact on their over all health.
Upon further research we discovered a power point presentation by Terrence Sheehan, MD Chief Medical officer and Director of Amputee Rehabilitation Program at Adventist Rehabilitation Hospital in Rockville, Maryland. Though his topic was Physical Issues Following Limb Loss: Adapting in the Context of a Natural Disaster. It had some statistics and information very relevant to anyone and especially someone with diabetes.
At my last podiatrist appointment, he commented he hadn’t had any new Charcot
patients and was kinda surprised. His nurse, however, may have hit on the answer. She said most go to emergency or urgent care and end up having to have the limb amputated because they went for help too late. If they had gone to a podiatrist when they first had foot problems and had been diagnosed correctly. They could have avoided amputation.
January 2004, the diabetic doctor told me that Charcot was rare and not mentioned much in medical school. That’s why it was missed. The type of surgery performed was just taking the foot to the ankle as it was not infected. This was, sort of, a rare surgery for Charcot, but new procedure. The physician said I was a good candidate.
Though the surgery was a success and was healing well, I developed what was determined as gout. I was allergic to the prescribed med. Vioxx. This was like 4-5 days after surgery. Within 24 hours I started swelling up.
I wound up in ICU. After many tests it was determined my kidneys had failed. I was placed on continual dialysis for 5 days. After the five days, they had removed 100 Lbs. of fluid. I was still taking an antibiotic drip for eight hours, every 3 days to fight the MRSA. I was then transported by ambulance to their health care unit. My kidneys did not operate for eight weeks. So, I was placed on dialysis 3 times a week, 4 hours each session. Normally, it is a three hour session. They transported me to the Dialysis Facility (which had many, many machines) every Monday, Wednesday and Friday evening. The session began about 7 PM and it was normally midnight before getting back to the care center. This lasted, just, over four weeks.
During this process, I developed pneumonia. So in March, I was taken back to the hospital as this was my second bout with pneumonia. I was on oxygen for a few days each time and had to use the little breathing apparatus to clear my lungs and expand them. The surgeon had to place a port in my left side about three inches down from my shoulder so all meds were given to me went through it. They were constantly giving me something. After kidney failure another port was placed on the left side just to the right of the left breast so I could be hooked up to dialysis machine. I just about forgot, during the first bout with pneumonia, I was not eating, or would not eat and a tube was inserted through my nose to my stomach for the propose of feeding. I had that in from first part of February 2004 until end of February when I was moved to Providence Health care (Rehab and Senior Living housing)
Before Vioxx shut down my kidneys, I had been given an antidepressant. The doctor and nurses kept asking me questions after surgery. I thought I was doing OK, but they determined from my answers to their questions, and the fact that I was not eating, I was depressed. Again I really don’t remember much about the hospital and the pneumonia bouts. I really feel my poor body had been given so many drugs it revolted and said enough already.
Bonnie’s continuing story
I first learned I had Charcot Foot, I had to work at getting my feet healthy. I had calluses, but no open wounds, though I did have a sore toe which we learned was infected. I was instructed to get my feet healthy. Keep them clean, dry and soft. I used lotions morning and night spending a lot of time caring for my feet. Soon they were soft, no cracked heels and feeling much better. My feet had begun to deform, hammer toes and a small bulge on the inside of my right foot was showing.
However, when talking with Bonnie, she didn’t have the ulcers, calluses or deformities. Yet, she had the same pain and difficulty walking that I did. She had taken better care of her feet. Apparently, the destruction was internal, inside her foot. The bones were deteriorating and becoming weak. Thus the broken bone that led to amputation.
None-the-less, foot care is really important. I just returned from my appointment with my poditrist. I have him check my feet and trim my toenails because I managed to cut the end of one of my toes off several years ago because I could not feel the end of my toe. Seeing the blood gush from my toe convinced me I should not try this again. Plus the nails were getting thick and hard to cut. Anyway, I told him the end of my big toe was hurting some this past week. He said my toe nail was growing in such a way that I was getting an infection. That, I definitely did not want to hear. Fortunately, after he worked on my nail, it felt much better. I think it was rubbing on the inside of the shoe which didn’t help.
My next step, now, will be to go to the orthotics clinic. I had noticed a small callus starting on the ball of the left foot. The podiatrist gave me a prescription to get new orthotics. I see the podiatrist every three months , or sooner if necessary. After the appointment, he said my feet were stable. This was good to hear, as I am doing more walking and exercising.
From what I can tell, most of us that have had, or do have foot problems wait too long to seek help. When we do, the person we go to often doesn’t have the knowledge about the problem, such as Charcot Foot. Then the out come is the fact we are so bad that amputation is the result. They find it is easy to blame your weight if you are over weight. Then tell you, you need to loose weight, or diagnosis you with something that has similar symptoms.
Please use common sense and find the knowledgeable provider. Seek medical help as soon as a foot problem develops. Do not wait until you have to go emergency or urgent care for treatment.
January 10, 2004, the day I arrived at Providence Hospital in Anchorage by ambulance, started a wild roller coaster of four months. I had already spent the past three months at home on the sofa with my foot elevated dealing with wound care and an infection.
Now, the Doctors had to get my immune system and sodium levels up to be able to do exploratory surgery on my left foot. There was the strong possibility of amputation. Amazing that it took 8 days of medications, antibiotic drips and blood transfusions to get me prepared. I can not remember much of that 8 days for some reason, but I just don’t.
Before I started writing this, I called friend Sharon and asked if she remembered how I was responding to all this. She says I was pretty calm and just ready to get it over with. The day of surgery, Tony came in to see me. Since he was owner and operator of his truck delivery business, he had to work. Sharon sat with me at the hospital reporting by cell phone to Tony so he knew how the day was going. The Orthopedic doctor, Dr. Chang, performed the surgery. When he came in to see me, after surgery, he told me he was sorry he had to amputate, but the good news was the amputation was just up to the ankle. So, of course, that made me very happy. (Seriously, I don’t remember how I felt, but don’t remember being happy.)
After surgery, about two days, they had me trying to set up. The room was spinning big time. I was very nauseous. It took a few days of practice to pull myself up with a pull bar. (can’t remember what it’s called) After a few days I made it to the edge of the bed. My muscles were so weak (from laying on the sofa for 3 months with foot elevated). Then the process to learn to use a slide board to get from the bed to chair and back again. This was quite challenging. Again a day or two process, but conquered it.Then about 10 days after surgery, the attempt to stand using my right leg and a machine to hold me up. My right leg was like a noodle. I could not hold myself up with the aid of the machine and fell to the floor hitting my stump. Boy, did everyone jump through hoops to get the screaming, hurting lady in bed. Of course, the wound started bleeding, but no sutures were pulled out (a blessing). Sharon asked me if her pastor could come to visit me and I had given her my OK. During this time Sharon was bringing her pastor, Pastor Suzanne Wood to visit and pray with me (note my December posting).
The wound was healing well, but since I had MRSA, the strong antibiotic drip continued. Any visitor had to wear a gown, or mask, even hospital personnel. I was receiving so many calls from relatives and friends wishing me well. My room was full of flowers, stuffed animals and cards pinned on a big board. It was overwhelming to think I deserved any of this. My wonderful friends in the airline industry were working behind the scene on a surprise.
The bandage was changed every day and healing going well. My pain levels were not too bad. Plans were being made for me to start thinking about rehabilitation, and going home to a three story condo. I was getting stronger and stronger. About the 10th of February, I awoke to incredible pain in my left thumb and forefinger. My right thumb was swollen, red and also, in tremendous pain. Now, a big rush to find out what was causing this. After tests, it was diagnosed as gout by Dr. Lee. She prescribed Vioxx, an inflammation reducing medication. Vioxx was fast acting. That’s for sure – pain subsided, as did the swelling. But in a matter of 24 hours, I was having major problems. I started swelling up, could not urinate, had a very high temperature, and listless. The heart doctor and kidney specialists called for all kinds of tests. They moved me to ICU without calling Tony, or Sharon. It took several days for them to realize it was my kidneys. The tests started rolling one after the other and the doctors not agreeing on what was happening. I don’t remember what was going on, but with kidney function gone, my body was filling with fluid fast. I remember being taken to a room with a huge machine and being hooked up to it, and all of a sudden feeling like I was freezing cold. I didn’t realize it was a Dialysis machine. I did not realize that those who loved or cared about me had not been told where I had been taken. It took the hospital staff awhile to figure it out as there had been a shift change. Needless to say Tony and Sharon were quite upset.
Continuing Bonnie’s story