Amputees

Gordon McDonald, former military paratrooper and survivor of a rare auto immune disease.

In 2015 he underwent a stem cell transplant, although cured, Gordon was left with permanent damage to his legs and confined to a wheel chair.

In 2018, in an attempt to gain mobility, He made the elective decision to amputate both my legs below the knee.

Within the year he was fitted with new legs, adventure was within his grasp. Three years prior he started to follow Wim Hof, He needed help with PTSD and Wim’s breathing method and cold exposure really helped him gain control. “I was hooked and wanted to take it further”.

Setting his sights on climbing Mount Kilimanjaro in record time with the Legend Wim Hof. An opportunity to ask Wim Hof himself in person was possible if he made a trip to Portland for a five day workshop. Where he had to climb a local mountain bare chested, completing this would open the conversation about Mount Kilimanjaro.

He was able to attend week six of the winter expeditions, the last one before the Covid-19 shutdown. One-hundred and twenty people from all over the world gathered in one place. All here for various reasons; some personal goals, hidden fears, curiosity, reconnecting or an unknown attraction. He planned on attending as a precursor to Kilimanjaro,

“I learnt how to feel pain, to feel it without suffering. I learnt a deeper understanding of myself, I learnt not only love for others but love for myself, I learnt how to be kind to myself, to re connect with my soul, to my self.”

nothing more than a stepping stone to a furthis is called “Suffering.” ther goal. What was intended as a stepping stone turned out to be a discovery. Here To remain in the ice water without suffering Gordon found himself. is to Surrender. The object of the exercise is to relax, catch your breath, match the His first session with Wim, was guided breaths until calm can be integrated. While breathing, one hour of deep intentional maintaining calm breathing there is freebreathing at a rate of 50 breaths per mindom to explore, question, observe what you ute. 3000 deep breaths in rapid succession, are feeling, what is this urge I feel to get which allows for accessing a deeper level out? of our subconscious, a place where past traumas and pain can be observed and His group was solid, compassionate, unreleased. Tears poured from his closed derstanding, each and every one of them eyes, taking him back to unresolved pain connected, “the feeling was amazing!” or torment. Gordon was able to reconnect, realizations of why he was there in the first Day 4, the day he was there for, or so place. he thought, the warm up climb for Kilimanjaro. Gordon had the honor, to lead After a breathing or ice bath session they the group of 120 up the mountain. They would debrief, sharing their experiences were dressed in shorts and boots, no shirt. with the group. A very helpful technique, They had to integrate everything they had verbally expressing to an audience has a learned during the week about breathing, way of opening you up, vulnerability of self surrendering and committing to achieve the is a valuable teacher. It was “Self Love” he goal of the exercise. The first 10km of the was there to access, not adrenaline, advenclimb were steep, however manageable, ture nor the highest summit, just LOVE. it was a towards the summit where he had problems. His body was all over the place, Cold exposure, another element within Gordon’s legs were getting intermittent the three pillars of Wim’s principals that signals making it difficult to step, his friend prove one has the ability to have influence Silvana placed her palm on his lower back, over their autonomic nervous system. Cold somehow that helped with the signal to his exposure, breath work and commitment are legs, like an in-line signal amplifier. Watchthe key to accessing this level. ing the ground just inches in front of him, only focusing on what lies just ahead. It The next day they were to meet outside was his “will” alone that helped him in the dressed only in our shorts, everyone but final mile. He had been searching for the Gordon was barefooted. They all walked summit his whole life, parachuting, rock as a group to the local waterfall, barefoot climbing, martial arts, motorcycles, speed, on a rocky trail was a leveler. Watching danger and adrenalin. He never saw his the group gingerly take their steps, needlimit before, always saving a little reserve, ing concentration with footing, much like for the way back. The unnamed peak in Gordon with every step he take on a daily the Czech Ranges became his inner mounbasis. After a brief horse stance and some tain. For the first time in his life he saw his warm up exercises, the group was motioned limit, it surprised him. Gordon found peace to follow Wim whom had just plunged off there, no longer feel the need to chase the a cliff into the ice water below. Mahdi, one summit. He surrendered to the chase and of two instructors and Gordon scaled the choose to live a life of connection and love. small cliff down to the edge where he could Happy healthy and Strong.... take off his legs and follow the group into the water. “When the world settles and this time of segregation subsides, everyone will Dominic, the second instructor had prebe ready for connection. I would love to viously explained to the group the water be part of that, my intention would be to is ice cold, the autonomic reaction is to become a WHM instructor and share that remove yourself or to retract, to clench beautiful gift to our youth in their schools.” shoulders and rapid breathing takes over,

Skin Care of the Residual Limb One of the most talked about topics Q: Why is a proper fitting socket for amputees other than insurance and Q important? who will pay for my leg, is skin care. A: If the prosthetic socket fits optimally, I read numerous social media post about amputees doing some very usual things with their residual limbs. From applying harsh chemicals (bleach and detergents), alcohol (which is a whole other topic) and using a shower loofah to clean their not healed limb. A & skin problems are minimal. But even with good fit, normal morphologic changes such as muscle atrophy and fluid volume fluctuation can alter the stump-to-socket relationship and increase risk of problems. Proximal constriction of the socket leads to vascular and/or lymphatic congestion and distal In this Q&A let’s go over so simple edema, with increased pressure over the straightforward care advice for taking distal residual limb. care of your residual limb.

Skin that comes in contact with the A: Skin breakdown occurs at sites of socket of the prosthesis must be cared pressure and where lateral (shear) forcfor and monitored meticulously to prees are applied to the skin, particularly vent skin breakdown and skin infection. when moisture is present. Common pressure and shear injury locations Q: What is the first sign that you include bony prominences, the margin might a problem brewing with your of the prosthetic socket, and the distal residual limb? residual limb. A: Pain is the first indication of a problem, and the patient should remove The first sign of skin breakdown is the prosthesis and inspect residual-limb erythema (Erythema” means red-colskin when an unpleasant sensation is ored.), which may be followed by pain, initially felt. Skin problems can be seriswelling, blisters, and ulcers. Continuous and should be evaluated and treated as necessary by the patient’s health care practitioner in consultation with the prosthetist. As patients become familiar with recurrent problems, they may be able to identify which problems are

Editor & Host of Amp Life Talk Radio or infection. Patients with a sensory disorder should remove their prosthesis ing to wear the prosthesis causes more serious skin damage and can lead to skin infection. TIP: Although it is not possible to prevent all skin breakdown, several minor and manage them on their own. several times a day to check the skin for measures can help prevent or delay skin However, anything unusual, persistent, painful, or worrisome should be evaluated by the practitioner. redness and other signs of breakdown or infection. Other patients should check for these signs at least twice (before & after use) daily. breakdown: • Residual-limb hygiene (morning and evening) wash with a mild body soap and rinse thoroughly two times a day

A: Disorders that decrease circulation to the lower extremities (eg, peripheral vascular disease, diabetes) and put paTIP: Skin problems and difficulty

and more often for patients who sweat more than normal.; your prosthetist can provide antiperspirant products specifically designed for amputees. • Maintaining interface and socket fit tients at risk of amputation also increase tissue beyond bone termination, loose • Maintaining a stable body weight, the risk of skin breakdown and infection after amputation. Disorders that impair sensation (eg,

this is the best way to make sure the prosthesis continues to fit; even small changes in weight can affect the fit. • Eating a healthy diet and drinking diabetic neuropathy, other neurologas possible during surgery, although water throughout the day. This helps ic disorders) can delay diagnosis by preventing patients from feeling dis

control body weight and maintain healthy skin. comfort or pain from skin breakdown •For patients with diabetes; monitor and

control blood sugar. • For patients with a lower-limb prosthesis; ensure that the prosthesis is aligned optimally.

A: When patients see signs of skin breakdown, they should promptly see their prosthetist to rule out prosthesis fitting as the cause and if necessary have the prosthesis adjusted. When possible, patients should avoid wearing the prosthesis until it can be adjusted. If the prosthesis is not the cause, or if fitting adjustments do not correct the problem, medical evaluation should be done.

TIP: Skin infection In normal, healthy skin, bacteria and fungi are kept in balance by dry, intact epidermis. However, the residual limb is contained within an interface, some form of viscoelastic gel layer or plastic, that creates a warm, moist environment that encourages growth of bacteria and fungi and development of infection.

A: Damp skin tends to breakdown, giving bacteria easy entry into the body. As a result, infection may spread.

A: They may include tenderness, skin erythema, pustules, ulcers or necrotic areas, and purulent discharge. A bad odor may indicate infection or poor hygiene. Minor bacterial infection may progress to cellulitis or produce an abscess; in such cases, patients may have fever and general malaise.

Any of the following sign of infection should be evaluated promptly. Patients should seek immediate evaluation for the following symptoms: • The residual limb feels cold (indicating decreased circulation). • The affected area is red and/or tender. • The affected area gives off a bad odor. • Lymph nodes in the groin or armpits proximal to the residual limb enlarge. • Pus or a discharge is present. • The skin becomes gray and soft or

A: Treatment of bacterial infection typically involves local cleaning and topical antibiotics. Sometimes debridement, oral antibiotics, or both are needed.

TIP: Typically, the prosthesis should not be worn until the skin infection is resolved. Erythema can indicate serious medical issues, which must be diagnosed and treated by a physician. Measures described above to prevent skin breakdown also help prevent infections. Fungal infection can be treated with an over-the-counter antifungal cream.

A: Ingrown hairs and folliculitis, although not dangerous, can cause substantial pain and discomfort. Not shaving the hair on the residual limb can help prevent these problems.

Verrucous hyperplasia is a rare, serious skin condition of the distal tissues of below- and above-knee residual limbs consisting of rough, erythematous papules that coalesce to form plaques and warty bumps. It is caused by a combination of an ill-fitting prosthesis socket that compresses veins and lymph vessels, the loss of the normal venous and lymphatic return due to muscle contraction, and dependent edema of the distal stump. Verrucous hyperplasia is rare today because of improved socket design that incorporates distal/terminal compression of tissues to provide a back pressure. If the disorder does develop, patients should remove the prosthesis for a week and have socket fit adjusted, which typically corrects the problem within 2 to 4 weeks. However, this disorder can lead to serious infection if untreated. If bumps resembling warts appear, patients should immediately consult the prosthetist to have the socket adjusted.

A: Even after the residual limb matures 18 to 24 months post amputation, edema can still occur. Having a well-fitting prosthesis socket is the best way to maintain a consistent residual-limb size and volume.

TIP: Measures that can be used when not wearing the prosthesis include applying external compression with: • Elastic bandaging • An elastic compression garment • The viscoelastic interface used when wearing the prosthesis

It also helps to follow a consistent nutrition and exercise program and do exercise and/or physical therapy to maintain muscle mass. Edema is much less of a problem when the amputation procedure is done in a way that preserves some active function of the transected muscle.

A: In hot and humid weather, the residual limb may swell and sweat, making the prosthesis hard to put on.

TIP: Showering, or immersing the residual limb in cold water for 3 to 5 minutes, and patting it dry immediately before putting the prosthesis on may help. After the prosthesis has been on for 5 to 15 minutes, it should be removed and immediately put back on. This strategy helps get the residual limb properly positioned within the socket. If cold immersion is not readily available, wrapping the residual limb with an elastic bandage or wearing the viscoelastic interface and elevating the limb for 20 minutes or more helps. Although prosthetic suspension systems that hold the prosthesis in place using vacuum (created by an electric or mechanical vacuum pump) might be expected to cause edema, they do not when the socket fits optimally.

Always seek the advice of your doctor if you notice or think something is not right with your residual limb, do not post photos on Facebook and seek medical advice.

SATURDAY, APRIL 18, 2020 | 8:00 A.M. – 4:00 P.M. Encompass Health | 1303 Mable Avenue | Modesto CA, 95355

April is limb loss awareness month, and Encompass Healthcare and Hanger Clinic have partnered up to bring you Run, Walk & Kick, an event aimed at raising awareness for the limb loss and limb difference community, their families, and caregivers. The day will be filled with expert knowledge and education for those affected by limb loss as they build their independence through increased mobility. This event is open to anyone in the limb loss and limb difference community, family members, therapists, caregivers, and volunteers.

EDUCATION + ACTIVITIES + PEER SUPPORT • Gait training and assessments • Prosthetic evaluations, assessments and physical therapy tips • Walking clinic and walking course • Virtual Reality: MiGO peer support • Two mile fun run & walk • Amputee classes: Putting on & cleaning liners, socks, • Nutritional advice for diabetics prosthetic sleeves, etc.

FOR QUESTIONS OR TO VOLUNTEER, CONTACT:

Sean Harrison, Hanger Clinic | (209) 672-7347 Lisa Clawson, Encompass Health | (209) 404-9876

CONNECT WITH US

a certain parameter will behave (degrees of freedom [DOF]). With this in mind, it is known that each finger to a hand has 4 DOF and the wrist has 3 DOF, which means that a prosthetic hand has to be designed to function with 23 DOF. It is quite difficult to control the movement of such a complex machine and so a basic two to three fingered prosthetic hand is usually designed for better control over the monitoring of signal patterns. The thumb actuator works with two degrees of freedom (DOF), which are comparative to the MP and IP joints. The modeling of heavy actuators results in a lower DOF, which can affect the ability of the prosthetic hand to grasp objects effectively. The following video is a good example of a patient adapting a myoelectric prosthetic hand controller with signal activity being monitored.

To take this journey of prosthetic hand construction a little further into detail, we need to consider the application of the sensor-controller-actuator system when measuring micro-electric signals. An electromyography (EMG) signal is used to detect electrical stimulus from the robotic hand, as would have been the case if the real limb was present. Electromyography involves the use of surface electrodes to monitor muscle activity and when considering bionic signals, this method of signal control is ideal to monitor exactly how the mechanical device is moving and responding to stimuli. The EMG is particularly important as it provides the functionality to amputees and the basic principle of EMG signals is to pick up a signal based on the movement of a limb or robotic form. The video below demonstrates the use of a robotic hand with one degree of freedom to pick up an object and how EMG is used to map the electrical signals during this movement. 34 AMPNATION

Plant-Based Diets for CVD Prevention A plant-based diet is a powerful In our clinical research studies here at the Phytool for preventing, managing, and sicians Committee for Responsible Medicine, we’ve put a plant-based diet to the test with even reversing type 2 diabetes. thousands of patients who have type 2 diabetes.

In a 2003 study funded by the NIH, we determined that a plant-based diet controlled blood sugar three times more effectively than a traditional diabetes diet that limited calories and carbohydrates. Within weeks on a plant-based diet, participants saw dramatic health improvements. They lost weight, insulin sensitivity improved, and HbA1c levels dropped. In some cases, you would never know they’d had the disease to begin with.

Studies show that eating a diet high in fatty foods can cause fat particles to build up inside our cells. These fat particles interfere with insulin’s ability to move sugar out from our bloodstream and into our cells. Instead of powering our cells, the glucose remains in our bloodstream, eventually leading to diabetes. A plant-based diet is low in fat, which allows insulin to function properly.

Evidence shows a diet of fruits, vegetables, whole grains, and legumes can prevent and reverse diabetes.

Diets high in animal products and added oils are linked to increased diabetes risk.

Beans, oats, sweet potatoes, and other low-GI foods do not spike blood sugar.

Found only in plants, fiber helps improve blood glucose control.

“ A plant-based diet is a powerful tool for preventing, managing, and even reversing type 2 diabetes. Not only is this the most delicious ‘prescription’ you can imagine, but it’s also easy to follow. Unlike other diets, there’s no calorie counting, no skimpy portions, and no carb counting. Plus, all the ‘side effects’ are good ones. ” 1

1Neal Barnard, MD, FACC, President, Physicians Committee

The present article has introduced a basic overview of the design and modeling of a prosthetic hand, a study referred to as biomechatronic design. Though the design of prosthetics is continuing to develop and benefits many patients living with an amputated limb, there are still challenges ahead in the design of a prosthetic limb that satisfies intricate requirements, such as easy control of the prosthetic limb and a to make this mechanical device cosmetically appealing. There is also the challenge of understanding the issue of tissue reactions to material used for the prosthetic limb and how an inflammatory response to such a reaction may interfere with the signal transmission of biosensors.

A lot of work has gone into further understanding and replicating the movements of a human limb to better design robotic hands that can perform as well as or better than human hands. Analysis of available prosthetic hands using computational approaches, revealed that symmetrical designs preferred by roboticists or the random designs generated come close to the abilities of a human hand. Thus, prosthesis designed with anatomically plausible asymmetry in joints and tendons can perform even better than human hands.

Another approach is to replicate the biomechanics of a human hand using biomimetic, mechanical design. The hands can be controlled via methods such as using electromyography signals from the residual limbs or by implanting tiny electrodes in the motor region of the brain or nerves responsible for controlling the hand. To control the movement of the fingers, new approaches have used cable-driven systems where strings replicate the tendons of the hand rather than conventional mechanical joints and transmission systems. This enabled the easier control of fingers as information about movement could be directly passed on to the prosthetic, rather than using complicated control systems.

The latest designs combine machine learning and neural networks to enable a user to simply think of a movement and the prosthetic performs it, just like a natural limb. A recent study reported a prosthetic hand combined with a neural network that can allow the wearer to think and move the hand. Electrical signals from the nerves are measured through the skin and sent to a computer that decides what the movement should be. The computer learns what the movement should be using a neural network trained to recognize different movements.

Another aspect of research into prosthesis has been enabling a prosthetic limb to feel. One report used sensors in the fingers to send signals to the nerves of the limb via an array of microelectrodes and wires that translate into a sensation. They may also be used to feel pain and temperature. Another approach has been to use a layer of artificial skin with sensors that are placed over the fingers on a prosthetic hand. The sensors relay the stimuli back to the nerve endings of the limb. Such a system can be used with any type of prosthetic hand.

Made by hand in small batches with 90 to 98% certified organic ingredients, with intention to heal. We make herbal infusions in an olive oil base to ensure excellent skin absorption and delivery of potent healing benefits. A Product I personally use.

Although there have been significant developments in prosthetics in the last few years, there is still a need for cheaper and more accessible prosthetics. More prosthetics are moving out of lab-scale testing and into the real world, opening up new opportunities and challenges.

Hook tions, and try to help ease Approximately 134,000 amnerves and work to help the putations occur annually in patient have the best posthe United States, resulting sible outcome for a funcmostly from peripheral vascular tional prosthesis. The team disease. The risk of amputation approach of the surgeon and increases with age, peaking patient advocate or compaamong those 85 years of age ny accomplishes a common and older. As a lifesaving and goal—restored mobility life-defining procedure, ampuwhere possible. tations result in physical and emotional changes affecting By consulting with a surquality of life. Phantom pain is geon on the exact location problematic for many patients, of an amputation—someand agents approved by the times even during surFood and Drug Administration gery—I am able to affect for phantom pain are nonexhow easily the patient may istent. Pharmacists should be adapt to a prosthetic limb. knowledgeable about weightbased dosing as well as patient Segment 2 - 5mins education guidelines. “The length of the limb and My limb was amputated and I was not consulted. Normally, there are a couple of reasons an emergency the amount of surface area makes a big difference when it comes time to fit a patient with a prosthesis,”. “For example, the more surface area there is at an amputation point reduces the risk of pressure ulcers and blisters, and it also increases the leverShow

Notes amputation may be performed. The first is when a traumatage area for applying the prosthesis which ic accident occurs. The limb could be lost at the scene of the sets the patient up for better balance. The team approach is all accident or maybe so badly damaged that it must be removed about making it easier for our patients to adapt to their prosin a hospital. The other common reason an emergency amputhesis and get on with their lives.” tation may be done is if a severe infection has set in, and the individual is going into septic shock. Septic shock can quickly While I recognizes that having a prosthetic limb is certainly a kill if not treated. In some cases, amputation may be the only lifestyle change, it does not have to be a lifestyle ending expeappropriate treatment. rience. Advances in technology and the evolution of prosthetic products have made a big difference for today’s amputees. Emergency amputations are very rare. Normally, there is time for a patient to discuss the pros and cons of amputations and Segment 3 - 5mins what other options may be available. The patient may be able My goal is to get people back to their normal lives,” and the to salvage the limb, but in some cases that may not be a good doctors I work with this is our goal. “Or if they want to do solution. more or different activities I want them to be able to do so, with the right prosthesis so they aren’t limited by their mobilIn most emergency amputations, the doctors struggle with ity.” the decision to amputate and may do everything possible to consult with family members and/or the patient. However, If you are facing a limb amputation, are struggling with a if a doctor truly believes that an amputation is the only way poorly fitting prosthesis, or something in between. to save the patient’s life, it may occur without the amputee’s approval. ..... Show Closing

I work with certain doctors to offer a unique model of care for patients who are facing a limb amputation. By partnering with a patient’s surgeon, I discuss concerns, answer ques

How long can the flu virus live on objects, such as doorknobs and tables?

The flu virus can “live” on some surfaces for up to 48 hours. Routine cleaning of surfaces may reduce the spread of flu.

48 hours

What kills flu viruses?

Flu viruses are killed by heat above 167° F [75° C]. Common household cleaning products can also kill the flu virus, including products containing: • chlorine • hydrogen peroxide • detergents (soap) • iodophors (iodine-based antiseptics) • alcohols

How should a caregiver handle a sick person’s tissues or other items?

Make sure to wash your hands after touching the sick person. Also wash after handling their tissues or laundry.

For more information call CDC info at 1-800-CDC-INFO (232-4636) or go to www.cdc.gov/flu.