Information and advice for amputee patients, their families and careers
What is Amputation?
The action of cutting off by surgical operation a part of the body, especially a limb or projecting part of the body.
Every year in the United Kingdom, there are approximately 6,000 new patient referrals to NHS prosthetic limb services prior to and following limb and digit amputation or congenital deficiency. Of these:
- lower limb amputations account for over
90%, with upper limb amputations accounting for around 5% and
congenital deficiency 3%
- less than 0.5% of patients are referred with either cross-site amputation, triple amputation or both upper and lower limb amputation
- the most common levels of lower limb amputation are trans-tibial (below knee) at 52% and trans-femoral (above knee) at 37%, with the most common causes being Peripheral Vascular Disease (PVD) (70%), trauma (8%), infection (6%) and neoplasia (3%)
- the most common levels of upper limb amputation are trans-humeral (above elbow) at 26% and trans-radial (below elbow) at 22%, with the most common causes being trauma (57%), Peripheral Vascular Disease (PVD) (10%), neoplasia (9%) and infection (2%)
- approximately one third of all new patient referrals are female
- approximately 2% of males and 4% of females are aged less than 16 and approximately 52% of males and 62% of females are aged 65 or over at the time of referral
- there are probably many more patients that are not referred for either advice or assessment.
(Information collated from the Amputee Statistical Database for the United Kingdom 2002/03). For more information click here.
The majority of leg amputations are performed due to the effects of blood vessel disease, such as hardening of the arteries, poor artery circulation or a large clot in the artery which cannot be removed. Less common reasons include cancer, severe injury or infection, and congenital deformities. Amputation is always a last resort and will only be recommended if it does not look possible to improve the circulation in any other way.
Arm amputations are much less common and are usually needed because of extensive injury or congenital deficiencies.
What is Rehabilitation?
The process of restoring someone to a condition of health or useful activity after illness or injury.
In the case of amputees or individuals with congenital limb absence this process is carried out both in hospital post amputation and in NHS Disablement Service Centres (Limb Centre) operated by Primary Care Trusts. We believe, as do the NHS and Independent Service Provider in a holistic approach to rehabilitation incorporating many different aspects of rehabilitation, carried out by the multidisciplinary rehabilitation team.
Currently there are an estimated 62,000 amputees in the UK, who have been referred to a limb centre for prosthetic rehabilitation. It is estimated that there are a further 40,000 amputees not wearing prosthetic limbs.
Every year there are approximately 6,000 new patient referrals to NHS prosthetic limb services generally know as disablement service centres or rehab centres. These referrals are prior to and following limb and digit amputation and congenital deficiency.
It is worth noting that not all referrals will go on to wear an artificial limb, also know as prosthesis. This will depend on the individual’s general health, mobility and other pre-existing medical conditions.
Exercise and nutrition
Exercise and Nutrition
by Christina DIMartino
Exercise helps pounds come off faster by increasing the amount of energy used. Extra calories are burned during exercise, but when done regularly, muscles use energy at all times. People are better able to keep pounds off if they combine exercise and a healthy diet. Exercise also helps to reduce hunger. Besides reducing the amount of fat on your body, exercise also tones muscles. These improved conditions help reduce the load on the overworked pancreas.
Beginning An Exercise Regime
The first steps toward a more active lifestyle should begin with a thorough medical examination. Because everyone is different, this is the only way to make sure exercise programs meet personal requirements. If you have diabetes, working with a health care team familiar with the disease will provide the confidence of knowing how to avoid pitfalls and reap the benefits of exercise.
Set realistic goals. Begin with simple exercises like walking. Build the program and increase goals slowly.
Exercise with a partner. Motivation helps to avoid discouragement.
Stick to a schedule. Make a firm commitment to exercising.
Alternate types of exercise to avoid boredom and body strains.
Reward yourself for sticking to your exercise regime, but avoid using food.
Make sure you hydrate properly during exercise. Drink
plenty of clear fluids before, during and after workout sessions.
People of all age groups should exercise. For those confined,
stretching on the living room floor is a great way to keep
the body fit.
Mechanical exercise equipment are excellent alternatives. Stairclimbers, treadmills, rowing machines, stationary bikes and weight machines simulate all types of normal physical activity.
Blood sugar levels will react to any type of exercise. Walking is one of the most often suggested, especially for those beginning a program.
Decreasing blood-sugar levels sometimes causes weight gain. To avoid unwanted pounds, exercise regularly and reduce caloric intake.
It's a good idea for children with diabetes to begin exercising when they are young. Exercising helps make children more confident and improves self-esteem. Parents should discuss exercise regimes with the child's pediatrician or diabetic specialist.
Injury is a definite concern for diabetics. Stretching prior to exercising and progressively increasing intensity and duration helps reduce this risk.
Exercise alone will not improve glucose control in Type 1 diabetes (insulin-dependent), but it will help control weight. Hypoglycemia is a risk, but careful balancing of food, insulin and physical activity will help to control it.
Diabetics should work closely with their health care team to develop good insulin control and a diet and exercise program to reduce the number of low nighttime low-blood-sugar episodes.
Be aware of how intense workouts are by monitoring pulse rate. Medical professionals can teach patients how to check their pulse.
Exercise can prevent type 2 diabetes (non-insulin dependent) from developing because it fights insulin resistance and obesity.
Nutrition and Diet
Diabetics should maintain blood glucose levels as near to normal as possible. Suggested goals are under 140 mg before meals and under 160 mg at bedtime. The best diet for a person with diabetes is like the best diet for anyone. Such a diet is low in fat; has only moderate amounts of protein and is high in complex carbohydrates, like those in beans, vetetables and grains (such as breads, cereals, noodles and rice). The American Diabetes Association's guidelines recommend:
Whole wheat, pumpernickel, or rye bread instead of white bread
Brown rice or barley instead of white rice
Oatmeal or sugar-free frozen fruit instead of frozen or canned fruit with sugar
Egg whites or egg substitutes instead of whole eggs
Low-fat cheese instead of regular cheese
Skinless white meat of chicken or turkey instead of dark meat or meat with skins
Game, lean pork or lean beef (round, sirloin or flank steak) instead of fatty meats like ribs or lunch meats
Fresh or frozen vegetables instead of vegetables with cream sauce
Olive oil, canola oil, or squeezable margarine instead of butter, regular margarine, lard or shortening
Skim milk instead of whole or 2 percent milk
Nonfat yogurt instead of regular yogurt
Juice instead of juice drinks with sugar
Fruit for dessert instead of pastries, cakes, pies, cookies or ice cream
Sugar-free soft drinks instead of regular ones
As the body changes throughout life, so do nutrition needs. The American Diabetes Association recommends all adults with diabetes see a dietitian who is familiar with the disease every six months to a year for help with meal plans.
