Leg Amputation and Your Recovery Leg Amputation and Your Recovery A guide for you, your family and friends 1 Leg Amputation and Your Recovery We gratefully acknowledge the following people and organizations for allowing us to adapt their original work for St. Joseph’s Healthcare Hamilton: Part 1: This information was adapted, with permission, based on a patient education book produced by Hamilton Health Sciences. Part 2: This information was adapted, with permission, based on content written by Sherry MacPherson, MSW, RSW and Penny Durnford, MSW, RSW Part 3: This information was adapted, with permission, based on a patient education book produced by Hamilton Health Sciences. PD 7688 (01-2012) File; peyles 2 Leg Amputation and Your Recovery Table of Contents Part 1 – What to expect in the hospital and Page 1 when you go home Introduction 2 Why do I need my leg amputated? 2 What happens before surgery? 3 What happens during and after surgery? 4 Who is on my health care team? 6 What happens when I am in hospital? 8 • stump care, pain control, emotions, diet and exercise How long am I in hospital? 17 Do I have rehabilitation after surgery? 18 What happens when I am at home? 18 What are the signs of infection? 18 When can I return to work? 19 When can I drive? 19 When should I see my doctors for follow-up? 19 What community supports can help me? 19 How can I help my recovery? 19 How can I look after my other foot and leg? 20 How can I make my home safe? 21 3 Leg Amputation and Your Recovery Part 2 – Your feelings and your recovery Page 25 Introduction 26 What can I expect to feel after having an amputation? 26 How can I help myself adjust to a leg amputation? 27 • Find positive meaning and purpose 27 • Regain control and independence 27 • Take care of your physical needs 28 • Take care of your spiritual needs 28 • Talk to people 29 • Take time with your partner 29 • Keep a journal 29 • Try not to worry about others accepting your 30 amputation • Be open and honest with children 30 • Plan and prepare for going out 30 • Know when to ask for help 31 Part 3 – Exercising after an amputation Page 33 Leg Exercises for Your Stump 34 Leg Exercises for Your Other Leg Only 36 Leg Exercises for Your Other Leg and Below Knee 37 Stump Arm Exercises 39 4 Leg Amputation and Your Recovery Part 1 What to expect in the hospital and when you go home 1 Leg Amputation and Your Recovery Introduction Having a leg amputation can be stressful. You may have many questions about your care. This book will help answer some of your questions. The information in the book is divided into sections. There is information that is important to know while you are in the hospital and information you will need to know when you are at home. Take your time reading the parts that are important for you right now. When you leave the hospital you will be on the road to recovery. However, you may not feel fully recovered for a long time. Keep this book and refer to it while you recover. Let members of your family and friends read it too. We hope this book helps you take part in your own care and recovery. Any member of your health care team will be pleased to speak with you at any time. No question is too small to ask. Why do I need my leg amputated? Many people with diabetes, heart disease and kidney disease have hardening, narrowing or blocks in the arteries that supply blood to the leg. This means there is not enough blood going to the leg. Diabetes can also cause damage to the nerves and blood vessels causing poor circulation, loss of feeling and slow healing in the feet. People with diabetes can develop ulcers or infections which may become severe and sometimes lead to amputation. When hardening of the arteries becomes so bad that pain is constant and severe, or skin begins to die, amputation may be the only option. If amputation is not done in these cases, then infection may start and be life threatening. Your surgeon has decided that it is not possible to increase the flow of blood to your leg or stop the infection, so you need to have an amputation. This book gives information about having a leg amputation and what to expect before and after surgery. If you have any religious beliefs about having a leg amputation, it is a good idea to talk to your surgeon before your surgery. 2 Leg Amputation and Your Recovery What happens before surgery? Removal of the foot or part of the leg is called a major amputation. A major amputation can be either below the knee or above the knee. The surgeon decides if you need an amputation below or above your knee. The end of the leg that remains after an amputation is called the stump. There are risks and benefits of any kind of surgery. Your surgeon explains these to you before you sign the consent form for surgery. It is important to have your questions and concerns addressed during your visit with the surgeon. Some questions to ask your surgeon: • Is amputation the best treatment and why? • How long is the surgery? • What are the major risks of surgery? • What are the major benefits of surgery? • What kind of pain will I have after the surgery and for how long? • How will my pain be managed right after surgery? • What kind of anesthesia will be used during surgery? • How long will I be in the recovery room? • Will I be able to use an artificial leg called a prosthesis? If yes, how much function will the prosthesis provide? • What are some of the possible complications after surgery? 3 Leg Amputation and Your Recovery What happens during and after surgery? The Operation Operating Room When it is time, you are taken to the Operating Room. This room is bright and cool. You move from your stretcher bed onto the operating room table with help. The team then goes through the steps of preparing for surgery called a “surgical time out.” They make sure they have the right patient and the right surgery before starting your anesthesia. The surgery takes 1 to 2 hours depending on what your surgeon plans to do. The incision is closed with staples, clips and/or stitches and wrapped in a thick bandage or a cast is put on. The Post Anesthetic Care Unit and Nursing Unit Recovery After surgery you go to the Post Anesthetic Care Unit (PACU). You are watched closely by the nurses and given pain control medication. You stay here until you are fully awake and then go to your bed on a nursing unit. There is a waiting room for your support person. Pain Control You may have pain and discomfort from your operation. Pain medication is given to you on a regular basis and as needed. If the medication is not enough, talk to your nurse and doctor. Intravenous Therapy The IV will give you fluids and medication after surgery. It is taken out when you are able to drink well. 4 Leg Amputation and Your Recovery Nausea Some people have nausea after a general anesthetic. It is important to tell your nurse if you feel sick to your stomach. You can have medication to help. Activity Exercise and activity are very important to help you recover. Moving helps keep muscles strong and prevent: • breathing problems • blood clots • constipation Your nurse will teach you deep breathing and circulation exercises which you should do every hour that you are awake. What happens after surgery on the nursing unit? On the nursing unit, the nurses check your blood pressure and incision sites on a regular basis. You may have a thick dressing on your leg to help it heal. The nurses change this dressing every day or two to help keep the incision clean and dry. You may have a cast instead of a thick dressing. This depends on your surgeon. The next day you begin having a regular diet. Your IV is removed after you are eating and drinking well. A cast or splint on your leg helps keep your knee straight. If you have a cast, it is often removed about 1 week after surgery. If you have a splint, your doctor or physiotherapist decides when you no longer need to wear it. Members of your health care team help you get to the bathroom as needed. Do not get out of bed without help. You are advised when it is safe to get out of bed and move around on your own. 5 Leg Amputation and Your Recovery Who is on my health care team? Members of your health care team have special skills and experience to help you after surgery The surgeon and residents continue to follow you until your stump is healing well. They help monitor your pain and order medications to help. They monitor your incision and your medical recovery from the operation. The nurse practitioner is an advance care nurse who helps manage your care with the surgeon, residents and other doctors you may see. The nurse practitioner gathers your medical history, does regular physical exams and works with you to address any issues you have. He or she may adjust or order any tests, treatment or medication you may need during your hospital stay.