Eastern Health’s Amputee Clinic
Jim Glavine was a linesman working in Nova Scotia when he suffered a traumatic accident in the spring of 2013 that resulted in the amputation of his right leg below the knee.
For a healthy outdoorsman who loved to hunt and fish, this was a drastic change in lifestyle that left him relying on others, especially his wife, Lisa, to help him get through the activities of everyday life. Activities that we all take for granted like getting a shower, moving from room to room in your own home and sleeping in your own bed – which, according to Jim, should be in the bedroom, not on the floor in the living room.
“It was a really rough time,” recalls Jim. “I was used to being on the go. When I wasn’t up on the pole for my job, I was out in the woods. After the accident, I tried getting around with crutches, but they didn’t work for me so I relied a lot on a wheelchair. There were even times I found it easier to get around the house on my hands and knees.”
Once he healed enough, his orthopedic surgeon referred him from his home in Bishop’s Falls to the Dr. L. A. Miller Centre in St. John’s to have a consultation with the Amputee Clinic and to be evaluated for a prosthetic leg.
Formed in April 2013, the Amputee Clinic offers one-stop consultative services to those who have had a recent amputation. The client meets one-on-one with a team of health practitioners which includes a physician, social worker, physiotherapist and a prosthetist, the person who measures, designs, fabricates and fits a prosthesis, or artificial limb. A nurse and an occupational therapist are also on staff for those who require their services.
The clinic was formed due to an increased need for amputee services. The fact is, the majority of amputations in this province are performed because of health issues – generally poor circulation resulting from chronic conditions – not accidents. In an unfortunate claim to fame, Newfoundland and Labrador has among the highest rates of both obesity and diabetes in the country. Combine that with an increasingly couch potato lifestyle, a penchant for salt, a higher than average rate of smokers compared to the rest of Canada and an aging population, the need for the clinic becomes clear.
A team approach
Mike Chislett, a division manager with the Rehabilitation and Continuing care program, stresses the importance of the team approach. “Having a whole team to consult with these clients is key and one of the real benefits to the amputee clinic. We can now provide a higher level of consistency and continuity of service for amputees throughout the province.”
“I felt they bent over backwards to meet my needs,” says Jim. “I was really impressed when I first came here that there were five people in the room just to meet with me. Everything was so professional.”
Out-of-town clients can also access the services of the clinic via videoconferencing technology called Telehealth. This can save valuable travel time, reduce hospital stays and improve the screening process as not all clients are candidates for prosthesis.
“The perception is that putting on a prosthesis is like putting on a boot,” says Mike. “But it takes a lot of energy and a lot of hard work to use a prosthetic limb. Believe it to not, it generally takes 20-30 per cent more energy to walk with a prosthetic for those with amputations below the knee and 40 per cent more for amputations above the knee.”
One of the main factors that improve recovery time and adaptation to a prosthesis is early client referral – getting the client soon after surgery for wound management, limb shaping, client education and before they form bad habits.
As well, in terms of leg amputations, the health of the remaining foot needs to be closely monitored because of the very high incidence of second amputation due to complications from chronic conditions. Life as a bilateral amputee is much more challenging.
“In preparation for prosthetic fitting, the client needs to follow a regular exercise program at home. Positioning the amputated limb is so important,” stresses prosthetist Ann Shigeishi. “Below knee amputees need to keep their knee straight and supported as much as possible. The muscles behind the knee can tighten, contract and then they can’t straighten their leg – which causes big problems when the time comes to fit them.”
Often times the physical healing is the easiest part as social worker Vurla Birnie-Lefcovitch, well knows. “When you’ve had a part of your body amputated, there’s a lot of adjustment and personal issues around how you view your body – your new ‘self,’ and your relationships both at home and in the community can change. Part of our role is not only to support the client through the healing process but also to screen them to see if they can manage prosthesis functionally, emotionally and physically.”
The clinic has been in operation for over a year. They are forming connections with other health care providers in the community and the province. The referrals are coming in earlier; clients’ physical aspects are being met – the exercises, the stretching to make sure their limb is good, strong, flexible and in a good position to be fit with a prosthesis; the financial aspect is addressed where needed; home supports are available and they’re helping clients adapt to their new body – with or without a prosthesis.
They’ve certainly made a difference for Jim Glavine who’s getting a new prosthesis and says he’s feeling better and better as time goes on.
“I’ve basically been sitting down looking up at everyone for the last year and half. When I first stood up on my new leg, I felt taller than everybody else. It sure feels good to just stand up and walk around again.” ■
This story was written by Robyn Lush, a communications specialist with Eastern Health.