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Mary Farquhar

Advice ....what questions to ask?

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Hi Everyone,

So only 2 more days until my Dr's appointment. I just realized I didn't write any questions down to ask him about amputating to a bk. I'm sure people on this Forum who have already been through this could help me out? I feel a blank, and can think of maybe 3 questions to ask. I want to be prepared going there on Friday.

Thanks!

Mary

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Questions link

Mary, the above link is actually questions to ask a prospective prosthetist...figure that one may come in handy, too!

As for your surgeon, at the least I'd ask them how many below knee amputations they'd done, what their philosophy was regarding pre- and post-op pain control, what they anticipated in the way of recovery time and physical therapy, how the surgery site would be cared for after the op.........

I'm sure I've forgotten some other good questions...so join on in, gang!

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Ask about how they would treat the nerves, veins/arteries, muscles, and bonebridge. They may not be an Ertl Dr. but they still may perform the same type of treatments. If you haven't yet, check out the ertlreconstruction.com site. Cutting the nerves while under tension will reduce the chance of painful neuromas. Individually stitching the arteries and veins together is better for circulation. Reconnecting the muscles give you better control. Lastly the bonebridge for fusing your tib and fib gives you a vast improvement in weight bearing.

I would also ask if they work with a prosthetist so that YOU will end up with a better fitting socket later.

That's all I can think of for now.

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A Dr. that I have seen many times and who also works at the rehab told me this Dr. I am seeing has done a few Ertl's. I have already seen this Dr. in the past. I will know more when I finally get to talk to him. I am planning on bringing all the info on the Ertl procedure which I printed out from that site. I want the " real " Ertl done.

I have talked to my prosthetist, and he did give me lots of info about what will happen after the surgery. He knows this Dr. very well.

I am wondering about the spinal epidurals or nerve blocks.....I read about people using that when having an amputation. Does anyone know about this?

Thanks!!

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Having an epidural both before and for a while after the surgery is supposed to be one of the better ways out there to "derail" any future phantom pain. I did not have that done specifically as part of my prep...but I did have an epidural for the exploratory surgery on my foot, which happened just a couple of days prior to my amp...and I was kept on some pretty heavy-duty pain meds between the exploratory and the amp. Basically, I "followed" the recommended pain prevention regimen without actually knowing that was what I was supposed to do! I guess it worked, as I've never had major pain problems....... :wink:

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Hi Mary

I know we have spoken before, and am glad you are finally getting to see someone and getting your questions answered.

I must admit I know very little about the Ertl, but generally I would be asking him particularly aboutwhat the others have said about the nerves, and about bevelling the bone at the end of leg, where the scar- line is going to be. I think possibly also, would be finding out how often he does this operation and whether he works with rehab consultants or prosthetists, and is aware of the optinum length of stump to accommodate modern prosthetics. You are looking for a good shaped stump, not too long and not too short, ideally with some padding over the bone at the end.

Possibly too asking him about the type of anaesthetic, painkillers etc. etc.

As you have read on hear many people advocate epidurals before, during and after surgery which is thought to be helpful longterm in reducing phantom/nerve pain. I myself had an epidural along with a general anaesthetic when I had a revision a while ago. The epidural stayed in about five or six days and worked very well at pain control... prob has disadvantages too, like lowering blood pressure, and keeping you in bed and perhaps necessitating a catheter. So there are always swings and roundabouts, but it worked well for me. Long term, I, personally am not too sure of the differences, having had the initial amputations done in an emergency without epidural, don't get a lot of nerve pain anyway. Some people have epidurals with a GA, like me, some have them with sedation some just have a GA.

Also the usual questions, like, how long will I be in bed/hospital, what can I expect when I return home etc. etc. Ask about stiches etc. What you can expect straight after the surgery, will you have a drain in etc. What is the best clothes to take into the hospital with you ... you know practical things that us girls like to think about.

Different places have different ideas, but have you located a prosthetist yet, and do you know if you will be returning home after surgery or perhaps going to a rehab centre, will you be getting physio etc. Think about your house now, is it going to be easily accessible from a wheelchair or on crutches, those sort of things.

With a bit of luck the right doctor will answer most of those questions before you ask them ... but be sure to take the questions in with you written down .... just in case .... if you are anything like me your mind will go blank and you will forget otherwise.

Ann

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Mary: sorry if any of this is not relevant to your case, but I haven't been following messages from you. Apologies.

Questions for surgeon etc.

Not many for the surgeon - as long as the hospital you're attending has a wide experience with amputations. You could just ask whether your particular knife-man does many (on the basis that he COULD just be popping in for the day from a non-bone hospital), but apart from that, I wouldn't bother him/her much.

You could demonstrate your knowledge (and thus keep him on his toes) by asking whether your stump will be the optimal length for a prosthesis (which I believe is 170mm from your patella). (In some cases, it is necessary to cut it shorter than that for surgical reasons).

But I can't emphasise enough the VITAL importance of what Cherlym said, above, about anaesthesia. It is crucial, both for your operation, the post-operative period, and the MUCH longer term. The theory, anecdotal but confirmed by the experience of MANY amputees (me included), is that if you go into the operation PAIN-FREE you are MUCH less likely to suffer from 'phantom' pains. Phantom pains are in many ways worse than 'real' pains - feeling your foot hurt and not being able to (at the very least) rub it better is a dreadful feeling. I have only experienced it very occasionally, thank the lord.

See the anaesthetist and ask whether you can have (if you want it) local anaesthetic rather than general, and unless there's a good reason, don't be dissuaded (one surgeon told me that he didn't agree with local anaesthetics because it meant he couldn't talk freely to his pals during the operation! I kid you not). Local will mean your recovery is far quicker than general.

Next question for the anaesthetist is about epidural. Basically, what seems to be the ideal is that you are connected to a morphine drip at least 12 hours before your operation, plus 12 to 24 hours post-operation. Tell your brain there is no pain.

Painkillers: whatever you are now on, can you increase them to their maximum in the days pre-op to help fool your brain that your leg doesn't hurt? Shouldn't be a problem.

Next, and I know it's early, but while you're there... can you see the senior physiotherapist? This is partly for your peace of mind, because once the operation is out of the way your Big Question is going to be: "How soon can I walk?" Although to some extent this is down to the prosthetics department, your physio will get you out of your wheelchair, onto various pre-prosthetic devices, walking between bars in the gym, and after a few weeks (5 or 6 ought to do it unless you have new problems) onto your first plastic leg and skipping away into the sunset.

Your relationship with your physio is incredibly important. Once you are walking, your relationship with your prosthetist will become more important. After which, hopefully, you can get on with real-life relationships instead.

I know this is late, Mary, but it might help focus your mind tomorrow. Good luck.

Allen, bka, London.

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