Help for possible amputee

[2DogsFarm]

A close friend is facing possible amputation - below-knee - due to severe fractures of a limb already compromised with medical hardware. Surgery scheduled for next week.
While I am hoping - as she is - that surgery can spare the leg, it is a very real possibility that it cannot.
Has anyone here had a leg amputated & how hard was adapting to the prosthesis?
We are {ahem} Old People (70s) & she has had problems for many years - multiple knee replacements, & back/neck surgeries.

I had a mastectomy, so I understand how hard it is to adjust to losing a “part” - and I realize a boob is minor compared to a limb, but still, it was ME.

I cannot be there for her, but she has her husband who is capable & supportive.
If there’s anything I can do or say or send to support her through Worst Case, please let me know.

[pegasusmom]

My son lost his lower right leg at age 24, collateral damage due to a catastrophic cardiac illness. He had previously evented through intermediate level and played A grade polocrosse. He was back on a horse the day he was released from rehab, played polocrosse for about 18 months post amputation and has since returned to Eventing. Currently competing at training level. He rides with a prosthetic leg, There is also a prominent dressage judge in our area who is a below the knee amputee, and has competed at quite a high level.

You didn’t mention what type of riding your friend does, and granted there’s an age difference between 30 (now) and 70, but it is entirely possible to ride with a prosthetic leg, and ride well.

I’d say the medical community did a fabulous job of saving my son’s life but did not much to address the depression that came from two open heart surgeries and an amputation. Make sure your friend has researched all the aspects of amputation so she can make informed choices.

It’s not easy, but it’s not the end of the world, just the start of a different one.

[Foxglove]

A woman who is an occasional guest at my hunt rides with a prosthetic leg. She is a beautiful rider with a very nice horse. The way I found out she had a prosthetic leg was when I asked her to join us in the club house after her first time out --she said she would but she needed to change her leg to her walking leg from her riding leg. Seeing her ride or walk, one would never know.

[wsmoak]

A decade ago, a family member shattered a lower leg. They warned us that it may need to be amputated. One year of surgeries for bone grafts and rods (didn’t work) and another year with an external frame on it, which involved re-breaking it to lengthen the bone (worked!) and it’s mostly okay now, but definitely not as good as new. It hurts, it doesn’t work quite right, we think there was damage to the foot that was missed while everyone was focused on the leg. This was a ~40 year old in good shape, and getting the bone to heal was challenging.

I’m sharing this to maybe shift the perspective from the amputation being the “worst case” – the repair work may be long and arduous, especially if it sounds like there is previous hardware in there.

[2DogsFarm]

Thanks, All

I was hoping for some {ahem} Elderly Recovery info, as friend is not in the best shape aside from the fractures. Both bones in the lower leg, broken in a fall from bed.
Replaced knee in the other leg also fractured & scheduled for repair in future surgery.
5 total knee replacements & a rod in the leg to be operated on that goes nearly to the ankle.

Her riding days are long over, walking is a trial & has been for some years.
Saddens me, as we met horseshowing Hunters back in the 80s & she was an avid Horsecamper/Trailrider all over the country - mainly Midwest - for many years.
My current TWH was a gift from her when I lost my WB 5yrs ago.

I know it’s possible to ride with a prosthetic, even drive < Andy Marcoux comes to mind.
But what I was looking for is some way to ease the transition IF it comes to that.

I had an implant done at the same time as my mastectomy, so the healing for me was easier as I had my “foob” right away.
I know that is not possible for her & wondered if anyone had experience dealing with adapting

[Where_sMyWhite]

What discussions have there been with the surgeon with respect to post-amputation (if it happens) rehabilitation?

If there have been none, I would personally not go through surgery until a very clear rehab plan was in place. I would not go into surgery hoping for no amputation to wake up and find out it has happened but bewildered by next steps. But, I’m also a planner person.

Too early to know but will her leg be a good candidate for a prothesis? A good rehab plan, IMO (I’m not a Dr nor PT or OT) should encompass both PT and OT (activities of daily living… bathing, toileting… her life will change regardless of prothesis or not). It should also include consulting with a mobility specialist who can help guide decisions on mobility options.

I would be looking for a rehab hospital that will offer PT/OT up to 5 days a week. Yes, you stay there but you also get more focused care in the early stages.

While I have not personally had an amputation, I have experienced going into surgery hoping for the best and waking up facing a long recovery, starting in a wheelchair. I did in-patient for 2 months ( ) as I learned how to live life in a w/c. I have, over time, become less dependent on a w/c but it is still a reality. All my therapists were totally the best (in-patient, in-home, out-patient, on-going). While they didn’t specifically do any depression ‘analysis’, they were aware of it and would, at times, push me to do things I might not have wanted to do.

[pegasusmom]

I like the comment that amputation is not necessarily the worst case. If it allows her to be more mobile and pain free then it’s not all bad.

Good PT, good counseling. If it comes to amputation has she thought about an Ertl procedure versus not. How much leg would she lose. My son lost nine inches from the bottom of his heel and his surgeon was able to wrap the end of his calf muscle around the base. This placed the suture line on the front of his leg. You actually don’t bear weight on the end of the stump but are suspended by the socket. Different types of sockets, and as the stump changes the need for a new socket occurs.

Son walked the first day he had his leg.

Be open and supportive. Let her grieve. There are Facebook groups around for amputees and the Amputee Coalition of American. I’ve found the FB groups to be somewhat depressing and not so helpful. ACA has great resources.

[2DogsFarm]

Again, thanks for the added info.
I’m afraid I posted too late for any of your great advice @Where_sMyWhite.
Surgery is Monday.
I too am a Plan B person. That’s how I prepared for my surgery, even to the point of convincing the plastic surgeon who did the implant that I wanted a lat-flap procedure.
And how I knew I could have both surgeries the same time & Medicare would cover.

She has mentioned rehab.
Has been there for prior surgeries & while her choice would be to go home ASAP, realistically she will remain in rehab if that is suggested.

I can only hope she discussed the possibility of a prosthesis, but from past I know she often does not think as far ahead as I do, or consider the What Ifs.

@pegasusmom I will send her a link to ACA. Thanks for that suggestion.

As I can’t now advocate for further research, all I can do is be supportive & hope for her desired outcome.

[Where_sMyWhite]

@2DogsFarm

wanted a lat-flap procedure.

Having nothing to do with the original topic… you’re the first person I know of that heard of this procedure… Had one but not for the same reasons as you but sure know the process. Mine was a bit more involved that what I understand the normal “use” is for that lat

I thought the surgeon was nuts that I wouldn’t miss that muscle. He’s right, I don’t think I ever have… I’m not a swimmer nor rock climber and everything, not a problem.

[2DogsFarm]

I specifically asked the surgeon if my riding would be affected.
He gave me the swimmer analogy.
I picked lat-flap as it seemed less (I felt)intrusive than other sites like abdomen.
For several months I could definitely feel the relocated muscle react like it was still in its original place. Weird feeling.
Riding never bothered me & I was back in the saddle in a little over a month post-surgery
But now, aside from the scar, it seems like it’s always been where it is.
In the last year or so, I have discovered I can no longer go braless for an entire day. If I do, that muscle gets fatigued & either spasms, or feels like a cracked rib.
Real 1st World Problem.

[B_and_B]

I have two good friends who are amputees, one is above knee, the other below. Both are elderly men. The below knee amputee I didn’t know about for years. He is very active with his own firewood business. The other man is in a wheelchair, but still does things like plow his own driveway with a snowblower!
In both cases, however, the critical thing is upper body strength. Their core and shoulders get much more of a work out. Obviously more so for the man in the wheelchair. But even the other guy has had to adapt, getting in and out of a truck for example. And part of that adaptation is better use of his core.
Of course, this is something that all of us ought to be working on as we get older! But I would be worried if her PT didn’t include some work on strengthening those areas as well. Good luck and good wishes to her and to you.