Pre-op:
My doctor send out prescriptions for post-op use prior to surgery, but some surgeons may order these while you're in the hospital. Either way, you should receive a prescription for 4 types of meds: an anti-biotic, an anti-inflammatory, one for nerve pain, and a pain killer.
The hospitals will generally call you a few days prior to surgery for registration, and medical history. They'll usually have you come in 2-3 hours before your surgery for some basic tests (blood, urine), and they'll have multiple people ask you the same questions over and over and over again. In some cases, they'll do a physical. (My doctor likes one done on each of his patients before surgery.) They should also put your IV in, and start you on a saline drip.
Your doctor should come in sometime before surgery and discuss the surgery with you too.
During the wait they'll have an anesthesiologist come in and discuss the plan of action with you too. There are a few different types of blocks they can do for this procedure. I had a spinal block the first time, and a localized block the second. Discuss with them any issues you may have with anesthesia. For instance, many times they use a mask to administer anesthesia, which I can't take. The mask traumatized me as a child, so I have to make sure they knock me out prior to putting the mask on me. I also tend to hallucinate from the anesthesia so they give me "Versed" which helps with that and also gives you a smooth awakening. Sometime slightly prior to knocking you out, they will usually administer something for your anxiety such as Valium through the IV. Valium in short, is a very nice drug lol. It calms you, and makes you happy... Anyhow!
The spinal block was given to me in the actual operating room. They had me sit on the operating table, and turn around. They said they'd numb the skin a little, and then give me 5 shots. While they were telling me, they also took my blood pressure. At the same time they started administering whatever they used to knock me out through the IV, but the tube got stuck under the blood pressure wrap, and didn't get to me until after the wrap was taken off. By this point they'd already given me 1 or 2 of the shots, unbeknownst to me. I felt the drugs kick in and in less than 30 seconds I was out. I can't remember for sure, but I think this block lasts for 12 hours.
With the centralized, they numb the spot for the injection, and shoot it in to the back of your leg, while you're in the hospital bed preparing to go into th OR. They administer the same IV drugs and get you rolling.
This is it for the pre-op conscious part.
The Surgical Process:
The skin:
They will cut a mostly straight line across the front of the leg where they have decided to amputate, while in the back, they will cut a "U" shaped flap, lower than the frontal cut. This will become the "bottom of the stump" skin and be sutured to the front piece to close it.
Different types of amputation methods:
ChopStick:
This type is commonly know as the chopstick method. (I tried to find the actual term for it but couldn't, so if anyone wants to help me out...) This is where the tibia and fibula are cut, and unbound to each other. This method leaves an amputee without a substantial platform to bare weight on later on. These bones can also move individually, and can cause a narrowing of the leg.
The E.R.T.L:
This method takes a piece of bone (usually from the discarded fibula), and uses it as a bridge between the remaining tibia and fibula. The doctor will anchor (anchor isn't the right term either, but it'll work) it in, and the bones will eventually calcify together. This provides the amputee with a strong platform to bare weight on, and a fixed positioning of the bones. Shrinkage of the residual limb is normal after surgery in any case, however this method shouldn't result in a the cone like narrowing thats seen with "chopsticks". Amputees with E.R.T.L.s can in many cases walk short distances on their stumps after they are fully healed.
Muscles:
In each method of amputation, muscles provide a cushion on the bottom of your stump, and are carefully positioned by the surgeon to do so, as well as create nice shape.
Time Line:
The surgery takes about 1-1.5 hours.
For a detailed look, check out this link for a CG amputation experience!
http://www.youtube.com/watch?v=XFb2fXPZi8A
Post-Op:
Upon waking, I didn't have any pain, both times, thankfully to the blocks. I did have a morphine pump available to me in case I needed instant relief, and was given a multitude of meds during my hospital stay. The pain wasn't nearly as bad as I had expected, and it mostly had to do with the swelling of the leg in the cast, or the cast keeping my knee straight. Percocet was also prescribed to me in the hospital which I found more useful than morphine as it took the edge off and didn't knock me out.
Hospital Stay:
Generally 3 days, 2 nights.
Post-Op Care:
On day 2, sometimes 3, they take the cast off and show you how to do dressing changes. Depending on who's caring for you, they may include an "end of stump" cast, as well as a knee brace. I'll be posting a separate blog entry about this topic, along with pictures and video.
Note:
Again, I'm not the standard patient. I was released on my second day at the hospital, both times.
Post-Op Appointments:
Post-op appointment with your doctor is usually 11-14 days after surgery.
If you're released before the cast removal, you'll need to have your cast removed. Mine was done by my orthopedic practitioner in his office shortly after hospital discharge.
When Do I Get My Stitches Out?:
All doctors have different opinions of when this should happen. Mine for instance likes to wait about a month. After this appointment, your doctor should tell you when he approves of you going to get started on your first prosthetic. Mine was a 1.5 weeks later.
Approx. Time From Surgery to First Prosthetic Fitting
APPROXIMATELY 1.5 months. It ranges for everyone so be patient.
How Long Until You Get Your Prosthetic?:
Mine took 3 appointments, in 2 weeks. Again, different for everyone. 1st appointment, scan of leg and/or mold taken. 2nd appointment, test socket (I think made of acrylic?) along with foot piece are put together, and you work out the kinks. 3rd appointment, you receive your new leg if all is well with it :)
Time Line for Both Surgeries:
I asked my doctor originally how long I'd have from first to second amputation. The original estimate was a year. However, my right leg was done August 19th 2009, and I just recently went through the second on December 30th 2009. The soonest he had wanted to do the second was February but based on my financial constraints, he agreed to do it before the end of the year. Also note that most people don't recover as fast as I do, as I'm used to doing it after so many surgeries. Plus, I'm awesome :)
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