Patient Information - Ask the Experts
Insurance
Q: My primary care doctor sent me to a specialist, do I need a prescription from the specialist or my primary care doctor to be fit with a prosthesis?
A: Any physician can write a prescription for your prosthesis. If you were sent to a specialist, he may have a preference as to what type of prosthesis he feels is best for you. In this case the specialist should write the prescription. The only reason you would have to go back to your primary doctor is if you had an HMO. In this case your primary doctor is responsible for generating the referral.
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Phantom Pain
Q: My dad has been having phantom pain lately. Is there anything you can recommend other than medication?
A: Some of the best suggestions come from others dealing with the same problem. I found a list of recommendations that I think would be helpful. Acupuncture and biofeedback are also techniques that have been used successfully with some people. You should always check with your doctor if you have any questions about any of the suggestions.
1. Wrap your limb in a warm, soft fabric, such as a towel. The warmth will sometimes increase circulation. Poor circulation is thought to be one cause of phantom pain.
2. Mentally exercise the limb that is not there in the area that is painful.
3. Mentally relax the missing limb and your limb.
4. Do some mild overall exercise to increase circulation.
5. Exercise the limb.
6. Tighten the muscles in the limb, and then release them slowly.
7. Put an ace wrap or shrinker sock on. If you have your prosthesis, put your prosthesis on and take a short walk.
8. If you have pain with the prosthesis on, take it and the prosthetic sock off and put it back on after a few minutes. Sometimes the limb is being pinched and changing the way it is on will relieve the pressure on that nerve.
9. Change positions. If you are sitting, move around in your chair, or stand up to let the blood get down into your stump.
10. Soak in a warm bath or use a shower massage. Sitting in a whirlpool or hot tub can also be helpful.
11. Massage your limb with your hands or better yet have someone else massage it while you try to relax your entire body.
12. Keep a diary of when pain is most severe. This can help you and your doctor identify causes for reoccurring phantom pain.
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Hemipelvectomy
Q: One of our good friends was in a motorcycle accident and received a (I hope I'm saying it right) hemipelvectomy. The complete left half of his pelvis as well as his left leg were amputated. What types of prosthesis are available for this type of amputee?
A: Socket designs (the part of the prosthesis that the person places his limb into) are limited. They can be fabricated out of laminated resin or from plastics. The socket fits around the individual’s lower torso with straps to secure it in front. Individuals with hemipelvectomies have to learn to operate 3 prosthetic joints (hip, knee, ankle). There are many components to choose from. An experienced Prosthetist can help make recommendations for the appropriate components and socket design. A great source for information on hemipelvectomies is
http://www.hphdhelp.org/prosthfram.htm.
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Is a prosthesis an option?
Q: My mom will be having an amputation below the knee. I’ve seen many wonderful stories on television about how well people are able to do with a prosthesis. She used to be a very active person and I’m hoping she will become active again. What type of prosthesis would you recommend for her?
A: I would strongly recommend looking into having your mom evaluated at one of the many prosthetic clinics in the Chicagoland area. In this setting, a Physician, Prosthetist, Physical Therapist and your mom will determine the best prescription. It’s important to note that your mom is part of this clinic team and should give her input. Many factors go into determining what type of prosthesis would be best. Age, strength, health, condition of her limb, activity level at the time of surgery, hobbies, are all factors used in deciding the best prescription. Once she receives her prosthesis, the clinic will prescribe therapy to teach her how to use the prosthesis. She will then be followed on a routine basis by the clinic team.
As a note, your first goal should be to get your mom back to her level of activity prior to the amputation. If your mom has been walking with a walker the past 6 months, don’t expect her to be walking without a walker after receiving the prosthesis. Some people will continue to progress to more independent levels of walking, while others will always need a walker.
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Equipment coming loose
Q: I wear an AFO on my right leg because of a foot drop. Recently, I’Ave noticed some red marks on my ankle bone after wearing the brace even for a short time. I’Ave also noticed that the metal piece that holds the strap is becoming loose, what should I do?
A: It is common for red marks to appear on the skin after wearing a brace. Usually these red marks are in the area of the strap or anywhere there is contact with the brace, even soft padding can leave a mark, like the way a tight pair of socks can. If the redness lasts for more than 10-15 minutes after removing the brace, or if there is a blister, sore or pain in the area of the red mark, you should make an appointment at the office you have been seen in to meet with an orthotist. It is very common for a brace to require adjustments. If necessary, methods such as adding more padding, heat relief and re-alignment of the brace can be used to relieve excessive pressure or discomfort.
The metal piece you are referring to is the rivet that holds the strap on to the brace. Occasionally rivets become loose, and they need to be replaced by the orthotist. This is usually a simple repair. You should make an appointment at the office you are being seen at to have this fixed. Please keep in mind that you can always call to speak with an orthotist with any questions or concerns you are having with your brace.
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Hard time fitting in shoe
Q: I wear an AFO and have the hardest time fitting it into my shoes, any advice?
A: This is a common problem patients have. The first thing you can do is check if the shoes you are wearing have a removable insole. This may require some tugging, but by removing the insole, you create some extra depth in the shoe to accommodate the brace. In most cases, gym shoes and regular lace-up oxford type shoes are the best to accommodate the AFO, but in many cases, modifications can be made to fit many types of shoes. If you are buying new shoes, it is best to bring the AFO with you to see if the AFO will fit. If there are shoes you absolutely must fit the brace in, make an appointment to meet with the orthotist to see if modifications can be made to the brace or the shoes.
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Brace not fitting properly
Q: My mom had back surgery and now wears a TLSO. It is constantly riding up and hitting her under her chin. Is it possible to trim the brace so this doesn’t happen?
A: It is possible to trim the brace, but this is usually not necessary. The problem you describe is common, and is many times a matter of fitting the brace properly. There are indentations in the waist area of the TLSO, these indentations should sit below the ribcage and above the hips in the soft “waist groove”. By positioning the TLSO there, it prevents it from migrating towards the head, especially when your mom goes from standing to sitting. Aside from positioning, keeping the straps fastened tight will prevent the movement. The straps should be as tight as she can tolerate without restricting any breathing. Some things to avoid might be sitting on a soft surface, like a deep couch, and instead using a firm chair. If there is ever any question as to whether or not the TLSO fits properly, make an appointment to see the orthotist to review fitting guidelines and proper donning/doffing (putting it on and taking it off) procedures.
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Feet Protection?
Q: I have diabetes, and have heard there are things available that can help protect my feet, what are my options?
A: Depending on what your doctor thinks is most appropriate for you, there are many options. In many cases, people with diabetes suffer from neuropathy, a condition that causes numbness or loss of feeling in the extremities. When someone is neuropathic, they are vulnerable to suffering a cut or a sore, and not even notice. These sores can lead to more serious infections, diabetic ulcers, and in extreme cases, gangrene and the need for amputation. In order to prevent a small sore from becoming a serious wound, diabetic extra-depth shoes, diabetic foot orthotics and special pressure relief devices are available that allow healing and provide the feet with a soft, accommodative environment. The best thing would be to talk to your doctor about some of these options.
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Should I continue to use my shrinker sock?
Q: I received a shrinker sock after my surgery. Should I continue to use it now that I received my prosthesis?
A: I recommend you consult with your doctor first.
A shrinker sock is used as a tool to control any swelling in your limb. Generally speaking, you should use your shrinker when you remove your prosthesis. This is especially important for anyone that has had an amputation due to vascular (circulation) problems. Keeping your leg elevated whenever sitting is also important even if you are wearing a shrinker. If you sit with your leg bent, it will allow fluids to accumulate and make putting on the prosthesis difficult if not impossible. One way to determine if you need to continue to use your shrinker would be to leave it off one night while sleeping. If you are able to put on your prosthesis in the morning, using the same amount of socks you wore when you took it off, then there is most likely no longer a need for the shrinker. If you can’t get the prosthesis on because of swelling, you will need to put the shrinker on and sit with your leg elevated until the swelling goes down.
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