Pain
Healing
Phantom sensation
Phantom pain
Post-Op swelling
Feelings after amputation
Impact on feelings
Sexuality
Muli-culture
After an amputation there will be pain associated with the surgery and the wound which usually requires strong medications. Staff will be working to ensure that your pain is controlled as well as possible. You need to report to staff any pain you have in the residual limb and take the prescribed medications regularly.
How long will my wound take to heal?
Ideally the wound heals in about three weeks post-amputation and during this time the aim is to reduce the swelling and protect the residual limb prior to the fitting of a prosthesis, if appropriate. For some people the healing process takes longer than this but this time is not lost as it enables people to regain general fitness and strength and increase the range of motion of joints which may have become tight after a period of limited use.
What is phantom sensation? Why does it occur?
Phantom sensation is a feeling or movement that involves the limb which is now absent.
Phantom sensation is almost inevitable following amputation of a limb. One theory to explain this is that the brain has developed an image of the limb which is recorded and when normal messages from the limb are lost due to amputation the brain attempts to reconstruct an image of the limb, hence phantom sensation. The positive side of this is that the brain has an amazing capacity to relearn and this is greatly helped by increasing normal input, for example, moving, touching or best of all using the residual limb to enable a new image of the limb to be created.
Phantom sensation is different to phantom pain.
What is phantom pain? Why does it occur?
Phantom pain sometimes occurs in the weeks following amputation and generally resolves over time in most people. It may return on occasions, for example, when you are generally unwell or there are particular problems with their residual limb but with a concerted attempt to move and use the limb the phantom pain should settle. Some people describe the pain as an "electric shock" feeling and it can last for seconds or for a much longer time, some people never experience phantom pain.
One theory behind phantom pain is that there is a loss of normal signals to the spinal cord and nervous system which causes confusion along the nerves and is perceived by the brain as pain. Phantom pain generally resolves over time and certainly becomes tolerable in most cases. One of the best strategies to manage phantom pain is to move and touch the residual limb and, as appropriate, use medication. It is important to talk to your doctor about this as they can find the right medication for you. Medication may include drugs that stabilise the nervous system and which are also used in treating epilepsy, or anti-depressants which similarly dampen down nerve activity and have the added benefit of promoting sleep. Occasionally muscle relaxants are recommended particularly if there is a feeling of spasm associated with the phantom phenomenon. Other treatments such as transcutaneous nerve stimulation (TENS) helps to block the pain transmission and is an important local management treatment for your residual limb.
There is more information on Phantom pain on the main web site click here
or go to Amputees in Touch and click on Phantom pain in the right hand column.
Post-operative swelling: What is it?
Following surgery it is normal for your residual limb to be swollen because there is oedema (or fluid) present in the tissues. The strategy is to reduce the swelling as quickly as possible to reduce pain and help the residual limb heal by reducing pressure on the tissues. The reduction of this swelling is known as oedema management. The commencement of oedema management may vary depending on the surgeon's orders and the viability or health of the tissues of your residual limb . The various forms of oedema management will be discussed in detail later in this booklet.
How you feel
As mentioned earlier, the decision to have an amputation is a major event in any person's life. Ideally, if time allows, you will have the opportunity to discuss the pros and cons of having an amputation with medical and counselling staff. It is important for you to try to discuss your feelings, concerns and fears, and to gain some understanding of the process that is likely to occur after your amputation. It may also be helpful to talk to an individual who has already had an amputation such as an amputee support person, or make contact with a local amputee support group.
How might I feel initially following amputation?
Reactions to amputation differ considerably. Some factors that influence the grief adjustment process are:
The nature/cause of your amputation.
How prepared you are for the amputation - prior knowledge of what will be happening to your body and recovery process after your amputation.
Your previous coping skills - including previous lifestyle and fitness.
It is common to experience an initial period of grief or adjustment. This can be due to your obvious physical loss and the resulting change in body/self-image and lifestyle. You will also experience changes in what you can do - sometimes things take longer or need to be done a different way. Sometimes there may be things that you cannot do any more.
Your feelings during this period are individual to you and it is natural. Losing a limb has been likened to losing a close relative, and the associated feelings may be similar. Feelings that people report commonly experiencing include numbness, anger, depression, guilt, isolation, anxiety and sadness. The duration of the grieving process will vary from person to person.
You are encouraged to meet with a counsellor to discuss any concerns you have about your adjustment response. Most often counsellors are members of the rehabilitation team who have had specialised training, usually a social worker or a psychologist. Counsellors are skilled at listening actively and attentively and providing feedback and helping people deal with their varied emotions. They have strategies that may assist you greatly in adjusting to your loss of limb. It is important to access the counsellor so that your recovery is maximised and your ability to return (as much as possible) to your optimum level of independence can be achieved.. You might have had a previous support person and you may like the counsellor to liaise with them. Alternatively it may be useful to be linked in with an outside specialist who you may feel is able to assist you further. Sometimes it is also be useful to discuss your feelings with an amputee support person who has a personal understanding of some of the issues you are facing.
Will my amputation impact upon my feelings longer term?
It is not expected that you have adjusted to having an amputation after a short time in hospital or in rehabilitation. As noted earlier, having an amputation is a major life change and it impacts upon your ability to continue life as it was before, and the time taken to adjust varies between people. You may feel that you have coped really well in the initial stages following your operation, or you may decide that it would be good to have some ongoing contact with someone to talk to about your feelings.
You may also find that you seek out support when different issues arise during your life at different times. As a teenager there might be concerns about changing schools or starting to date. As a young adult there may be concerns about finding a life partner or choosing a career. You might experience different issues when you consider beginning a family or when your children start school. As you age, you might have other concerns. At any stage you might find it useful to make contact with someone to discuss your feelings and help your continued adjustment as varied issues arise.
How might others respond to me?
Amputation does not just affect one person. It is normal for immediate family and close friends to also experience grief for your loss and how it may affect you. People close to you might also experience feelings of sadness or anger. Sometimes those close to you may find it easy to talk to you about their sadness, at other times they may try to maintain a certain 'braveness' so as not to upset you. Children are often curious about amputation and may respond in unexpected ways. Your family and friends may benefit from having someone to talk to about how they are feeling and they could also either access the counsellor at the hospital, or ask the counsellor for a contact closer to home.
Sexuality
Sexual response is tied up with our self-image and self esteem. These may be challenged when someone has a chronic illness or loses a limb. Your self-image is partly dependent on being accepted and affirmed within your significant relationships. In many established relationships each person will have been involved in preparation for amputation and the support will have been significant, however following amputation you may find that your relationship with your partner changes. Your partner may want to do more to help you or sometimes your partner may be reluctant to have physical contact in case they hurt you. Sometimes they are grieving and are feeling sad that the person they love had to have an amputation. It is important to have as open communication as possible so that you can discuss your concerns and your fears together.
There may be times when you experience pain or are physically unable to assume the same sexual position that you used prior to your amputation. You may wish to seek some advice on this by asking the occupational therapist or another member of the therapy staff who you trust.
The impact of culture
Australia is a multi-cultural community and people from all ethnic groups suffer limb loss. We recognise that people from different cultures may respond differently to amputation. Your own cultural background may influence how you grieve and cope with your amputation, and how those close to you cope. Please try to explain to treating staff what your amputation means to you (culturally) so that we can better assist you. Please also inform the staff looking after you if you would like to use an interpreter and they will endeavour to arrange an appropriate interpreter. Sometimes the staff may use an interpreter when they need to give you specific information or they are trying to understand more about how your amputation is affecting your life.
