Personal

Minor skin breakdowns and irritations are a common occurrence for the prosthetic users. A variety of lotions, potions, ointments and balms are used to help soothe, treat and heal these. Experiment with the following remedies to find what works best for you:

*Author's note: AmbuBalm smells like a poorly cooked lamb chop. A&D smells better, but both may cause a yellowish discoloration of your bioplastic liner material.

Most minor sores and skin breakdowns should heal up in a day or two with attention and treatment. However, if a sore develops which does not heal quickly, don't ignore this problem. See your prosthetist. Persistant sores are frequently due to movement within the socket or a shearing effect and may be cured by adjustments to socket fit. Stay out of your leg if necessary, until it heals.

Many of us have areas of skin where there is no feeling left on the amputated side due to severed nerves from surgery. Thus, you won't know or feel if a sore or blister is developing unless you look. So develop this habit; each time you remove your prosthesis, examine yourself in a mirror if necessary, to see if your skin is intact.

For hip-disarticulations: If you start feeling a little sore developing over your ischium (sitting bone), a small piece of gel filled material, called a TEC SPOT, can be inserted as a temporary fix until you can get to your prosthetist.

None of the current socket materials are breathable, so sweating remains an unending problem. Some ways of dealing with this are use of anti-perspirant sprays, roll on's, or solid anti-perspirant crystals, liberal use of talc or baby powder, and various undergarments.

Antiperspirants available by prescription only are "DrySol" and "Xerac AC". Check with your doctor. A non prescription antiperspirant containing Alum (called the Crystal) is available from Award Prosthetics:

Here is one home remedy which works to some extent: mix up 1 tsp alum (available in the spice section of your grocery) with I cup water. Place in aerosol sprayer or spritzer, spray on and let dry. In very hot, humid weather you may just have to remove the leg for a while to wipe off and cool down.

It may be possible to cut out sections of your socket for ventilation if you are a hip-disarticulation amputee. Check with your prosthetist to see if this will interfere with the suspension.

Punching holes for ventilation in a hemipelvectomy socket is not recommended by many CP's for several reasons. First it may decrease the weight bearing integrity of the socket, and will cause dimpling of the skin and possibly blisters. Some degree of vacuum exists inside our sockets, and if holes are made it will interfere with suspension and good socket fit. Lastly the movement of air will create embarrassing noises as you walk.

One of the first questions asked is what should I wear inside the socket? We all use something different such as: regular underwear, stockinette, Knit Rite prosthetic socks, bicycle shorts with one leg cut off and/or sewn up, one piece unitard, camisole or teddi. Some have adapted existing sewing patterns of bike shorts or panties and use cotton/spandex material to make their own undies. A commercial "hemi sock" made of COOLMAXŽ is available from Royal Knit, and can be ordered through your CP. For sizes and prices call (800) 664-5648. Another option is custom made "Hemi Underwear" made by "Fashion Magic." The owner, Ruth Clark, is also able to provide adaptive clothing for wheelchair users at the following address:

Men can usually get by with longer leg trunks with the missing side left intact or sewn up. Some ladies just use regular bathing suits, bike shorts or suits with skirts. For others who are concerned with modesty and some degree of fashion try this tip. Bathing suit material is available in most fabric stores and a small section of matching or coordinating fabric can be sewn into the missing leg opening.

Which gal is wearing a hemipelvectomy prosthetic? (Answer Below)

Answer: Both are left hemi's!

With the newer prosthetic cosmetic options available, most people will never realize you're missing a leg. We are able to wear pants, skirts, dresses and even shorts. If you find that your leg is creating holes in your clothing, or your components are eating holes in your cosmetic cover, have your CP put a thin layer of leather over the butt or thigh section of the cover, either inside, outside or both for protection and to prevent wear. This also works well for wear and tear at the knee if placed inside the cover. Some have found that the new artificial skin products are good protection, but others feel this is too restrictive to movement.

Dress the leg either on the floor, bed or couch before putting it on. This includes prosthetic stockings, socks or stockings, one pant leg and shoe. It is usually easier to pull your pants leg on over the foot first before donning the shoe. If the pants cuff is wide enough to pass over the shoe you can put the leg on first and then pull your pants on. With narrow pants be forewarned, they may get stuck and hung up over the heel.

May be chewed up by the hardware on your socket. Try using tape or small pieces of thin leather glued over screws, bolts or other scratchy socket hardware. Velcro straps eat pantyhose and will cause runs. There are many other types of straps and buckles and which can be used such as Dacron or leather straps, so discuss your various options with your CP if this is a problem. Thigh high stockings are a good alternative.

With either prosthetic use or crutch walking, we put a lot of extra weight and strain on our remaining sound foot and knee. Treat them like gold if you want them to last.

DO NOT HOP ON ONE LEG!! It's the worst thing you could do to your remaining joints. Use your crutches, get down on the floor and crawl or walk like a crab if necessary. Never walk barefoot, it's not worth the risk of possible injury.

I think, it's all a matter of choice, walking around with crutches puts tremendous stress on shoulders and arms, walking around with a prosthesis puts tremendous stress on stump and joints involved, even on one's chest in the case of hemi's. I DID HOP around a lot, especially inhouse, but also having danced a lot,, and sometimes even forgot to take my crutches to college (had to drive back, because of I never hopped for long distances...) . Therefore I can't agree completely with you, I would pose your statement in this way "Every amputee should be aware, that hopping around puts tremendous stress.... with age. Sooner or later one has to pay a price for this overload." Arno, (hemipelvectomy for 34 years, AK for 36 years, BK for 38 years - and still hopping around sometimes)

Our gaits and relying on crutches may cause foot pain. Be aware that this may not be a problem at first but may occur over time (the author, an aging amp can attest to this). An evaluation by a Podiatrist may prevent problems in your future. Commercially made or custom fitted insoles (orthotics) made to fit the contours of your foot can provide support, comfort and prevent injury.

The recent advertising of specialized "Prosthetic shoes" is a gimmick to get you to spend more money for an otherwise normal, lightweight, supportive shoe. It's recommended that you start with a low heeled shoe which will provide more stability and balance, but it is possible to wear a variety of normal, fashionable shoes with your prosthesis as long as the heel height is kept constant. You will be asked to bring a pair of shoes to your early fittings, which will be used to align your foot to the leg. Be sure the heel height is one you like since all future shoes should be of similar height. A heel which is too high will cause the knee to buckle, too low and you'll feel like you're walking uphill. Your CP should demonstrate this to you.

Some have even ventured into high heels, and strappy sandals. If you want to wear shoes of varying heel height there are some options: change the foot to fit the shoe, some people have a different leg for different heel heights. There are a few feet available which will allow for changing heel heights, without affecting the alignment. The pros and cons of these feet should be discussed with your CP. See the section on Components about these feet.

Other things to keep in mind when buying shoes; stay away from plastic heels, and slippery soles. Several of us will admit to ending up on our butts in the pursuit of fashion. Comfort and safety are the key. Look for shoes with some degree of traction on the sole, and preferably somewhat lightweight and supportive. Make sure your prosthetic foot is the same size as your sound foot. Also look at the soles, so they are not too stiff, will flex easily and will remain on the prosthetic foot. For men this is usually not a problem since most shoes will have laces, for us gals, slip ons can slip off. Always use a shoe horn, as trying to cram your foot into a shoe may effect the heel cup, and cause your shoe to fall off. And remember always try out walking in new shoes in the safety of your own home

Author's note: The author is an admitted shoe freak and does a lot of shoe shopping by catalogue. I have a list of mail order catalogues which offer sensible, fashionable shoes at reasonable prices. Most will also include heel heights in their catalogues. Contact christina@hphdhelp.org

"In Motion" Nov/Dec 1998 contains a number of articles generally relating to this subject which are recommended reading. Contact the ACA for copies.

Losing one quarter of our bodies is a devastating experience affecting both our body image and self esteem. We've all been through similar circumstances and each have reacted differently depending on our personal situation. Some have found support in friends and family. Others have been abandoned by their spouses and loved ones, but eventually, with time most have found ways of coping. How we are accepted and viewed by our families, friends and co-workers and society in general, frequently depends on how we've learned to accept ourselves in our new situation in life. Talking to other people who've been through similar circumstances is helpful, so if at all possible reach out and contact others on the support list.

"I've found that humor is a great tool. The ability to be light hearted and joke about my condition helps put others at ease when they first meet me. A joke or casual comment will break the ice and put others more at ease and willing to see me as a whole person" Rich, HP

"Never ascribe to malice, what adequately can be explained by stupidity". Arno, HP

Don't underestimate people. If you are comfortable and accept yourself, others will accept you as well" Mary W., HP

An excellent book on this subject has been written by Georgie Maxfield, an AK amputee, and is available for $10.95 which includes S&H. Proceeds of these sales go to a regional amputee support group. Copies are also available through the ACA.

The Novel Approach to Sexuality and Disability
NNASG
710 Marion Way
Sparks, NV 89431
(702) 358-8449

Resumption of normal sexual relations is possible and definitely recommended once post surgical pain is under control and you are able to move around comfortably. Without a doubt it may be awkward, can be embarrassing, and even painful at first. Body image as well as physical changes play an important role, and communication with your partner is the key. It is difficult to balance on one knee alone, so a change in position from what is considered usual and standard may be necessary. For both male and female, depending on which side was amputated, most have found that changes in position, either side to side or sitting may be more comfortable. Pillows or other supports may help. Be flexible, communicate with your partner and above all, keep a sense of humor.

For both hip-disarticulations and hemipelvectomies, it is possible to become pregnant, carry to term, and have a normal vaginal delivery after amputation if the female reproductive organs have been left intact. Good communication between yourself, your Obstetrician and your Prosthetist is essential for a healthy baby and mother. Be aware however, that any pregnancy may require a C-section for possible obstetrical reasons, non-amputation related.

Hip-disarticulations have an inact pelvis which will support the weight of a pregnant uterus. If you are a prosthetic user, it is possible to modify the socket by cutting out sections as the size of your abdomen increases. The decision to continue prosthetic use should be a personal one based on your level of comfort and energy expenditure. Labor and delivery will vary little from the norm.

Hemipelvectomies do not have one-half of their pelvis, and therefore the weight of the baby will cause your uterus to drop into the remaining pelvic floor interfering with socket fit. Lacking support on one side, the uterus may lie in a tilted position. As a result of this, an abnormal presentation, such as breech or transverse lie and prolapsed umbilical cord, have been reported. It may be possible to wear your prosthesis during the first trimester depending on the amount of weight gained. Some have remained in their legs into the 2nd trimester by having their CP make adjustments, cutting out portions of the socket or adding socket extensions to accommodate the growing baby. Most prosthetists and OB's with experience advise that it is best to stay out of the prosthesis after the 5th-6th month. Beyond this, the increasing pressure of the expanding uterus may interfere with suspension, requires a great deal of energy expenditure, and is very uncomfortable.

"With my first pregnancy I was able to remain in my prostheses up to the 6th month but it was exhausting, uncomfortable and not good for my baby, in my opinion. I'm now expecting by second child and got out of the leg at 16 weeks. For comforts sake, energy expenditure and health reasons this is definitely the wiser choice. Although I miss not being able to walk for a while, it's definitely worth it for both me and my baby" Mary W. HP

"I chose to get out of my leg at 2 months because the weight gain made it too uncomfortable to wear my socket. It took a while to loose the baby weight after delivery but I'm back in my prosthesis and walking again." Gabrielle, HP

Once out of your leg, a standard maternity support, elastic ace bandages, or a wide elastic lumbar support have been used. A pregnancy "support sling" has been advocated by at least one facility. It is described as a cross between a sitting socket with adjustable straps to support the abdomen and maintain the uterus in an upright and more anatomically correct position.

With only half a pelvis, the second stage of labor is usually shorter, although pelvic scar tissue must be taken into consideration. A C-Section is always possible. It also appears that HPs may be more prone to uterine and vaginal prolapse post-delivery. An Epidural for labor and delivery may be technically difficult to perform if you have a scoliosis, so an Anesthesia consultation early on is advised. For hemipelvectomies, sitting on an episiotomy can be painful. Consider use of orthopedic pillows and discuss this concern with your obstretician beforehand. After delivery, it may take several months to lose the weight gained during pregnancy. Be aware that it may not be possible to return to your pre-pregnancy socket if too much was cut out, or if your body shape changed with the pregnancy. You may require a new socket.

Author's note: Years ago when I was considering starting a family, neither my gynecologist nor my prosthetist could offer any specific information or guidance. There is little in the medical literature concerning this highly unusual situation. A n old review article listed 9 cases with 11 successful deliveries, however not everyone makes it into the journals. I now can add at least 5 more ladies who have had 7 normal pregnancies and deliveries recently, and probably more exist. For the benefit of the next mother to be and her OB physician, I ask all those mothers and their physicians who have experience to contact the web author at the address below. Hopefully we can create a network providing responsible, reliable information to the next young gal who faces the same concerns. I assure all physicians that your name or e-mail address will only be shared privately and appropriately with other M.D.'s. I will be happy to send you a list of journal references.