Creating Healthy Lifestyles
Healthy lifestyle practices such as daily exercise, eating nutritiously, and getting enough rest are important for everyone, but even more so for prosthetic users. The absence of a limb and a portion of the muscular-skeletal system can cause physical strain on the rest of the body, not to mention the emotional strain of adapting to limb loss. Both your initial recovery and your long-term wellness will benefit from committing to a healthy lifestyle.
Physical fitness is not something that can be achieved quickly or easily. Fitness is something that is built gradually and then maintained over the course of your life. New amputees and prosthetic users that want to get fit need to remember that trying to do too much too soon is counter productive. It takes several months for most people to recover from injury, surgery, cancer, chemotherapy or radiation. Your physical therapist can guide you in the early stages of rehabilitation and give you appropriate exercises to do on your own.
A comprehensive exercise program should condition both the upper and lower body as well as the cardiovascular system. Weight bearing activities and weight lifting are appropriate for most people and have the added benefit of strengthening the skeletal system. Swimming is a type of exercise that many amputees like as it strengthens the body and cardiovascular system without putting additional stress on the joints. What matters most is finding a form of exercise you really like and that fits into your life. It can be as simple as walking or riding a bicycle, or can involve joining a fitness center or going to an exercise class. You decide and then stick with it!
One of the primary benefits of exercise is that it helps you maintain a healthy, stable weight. It is not unusual for people who have lost a limb to be sedentary for a few weeks or months until their physical therapy begins. This can lead to rapid weight gain, causing challenges in both the prosthetic fitting process and in your rehabilitation. Gaining or losing weight has a major effect on how your prosthetic socket fits. Gaining weight can make the socket tight and uncomfortable; losing weight can cause it to be loose and more difficult to control. In either case, it is sometimes necessary to fabricate a new socket to accommodate the changing dimensions of the residual limb. Being overweight also reduces your stamina and makes it more difficult to walk on a lower extremity prosthesis.
Being active and maintaining a healthy weight also help prevent cardiovascular disease, the leading cause of death in the United States. About 60 percent of men over 60 and women over 80 will experience major narrowing of the arteries. In fact, vascular problems are one of the primary causes of lower extremity amputation in older adults. Many older adult prosthetic users are vulnerable to cardiovascular problems that stem from inactivity.
Emotions like sadness and depression can be immobilizing, but physical therapy and an on-going exercise program can help you reduce these feelings. Studies have proven that regular exercise stimulates the release of chemical endorphins that help lift depression.
As your energy and strength return, you may want to work with a physical therapist or professional trainer who specializes in athletics for people with physical challenges. Over the years, as more and more amputees express a desire to be active and engage in sports, many specialized organizations have formed to meet the demand. Two good resources for more information are the Amputee Coalition of America (ACA) and Disabled Sports USA (DSUSA).
Like exercise, eating right is not usually something that can be achieved overnight. Start with small changes and slowly add healthier food choices to your daily diet. If you have not already done so, reduce your intake of processed food and sugar, and increase your intake of water. In your daily diet, favor fresh vegetables and fruits, lean cuts of meat, low fat dairy products and whole grain breads and cereals. If you eat out frequently, look for lower fat/lower calorie options on the menu or ask for your food to be prepared in a healthier way. For example, if the salad has fried chicken on it, ask if you could have grilled chicken instead, or substitute French fries with green salad or steamed vegetables.
Good nutrition and regular exercise also have a positive effect on your skeletal system and help to prevent osteoporosis. Bone density, mass and strength all naturally begin to decrease with age as evidenced by the decrease in height that begins in men around age 40, and in women around age 43. After the age of 50, loss of bone tissue shows a marked increase, particularly among women. Most women will lose about 30 percent of their bone tissue, while men average a 17 percent loss. Millions of American women will suffer some kind of fracture this year due to osteoporosis. You can strengthen your bones by including calcium-rich foods in your daily diet like milk, yogurt, kefir, fish and dark green vegetables. Reduce your intake of caffeine, which blocks the absorption of calcium, and try to eliminate both regular and diet soft drinks from your diet. Depending on your specific situation, your physician may prescribe calcium and vitamin D supplements, estrogen or fluoride.
Finally, if you smoke, strongly consider quitting. You may feel that quitting right now would be too difficult but you can at least learn about your options. The US Surgeon General has stated, "Smoking cessation (stopping smoking) represents the single most important step that smokers can take to enhance the length and quality of their lives." You’ll find methods for quitting at www.cancer.org or www.smokefree.gov. Nicotine Replacement Therapy has helped thousands of people give up smoking for good.
Special Considerations: Hip Disarticulation and Trans-Pelvic
While all prosthetic users face challenges, those with a hip disarticulation or trans-pelvic (HD/TP) amputation face perhaps the longest road to becoming a successful lower extremity prosthetic user. Research indicates that people reject HD/TP limbs more than any other prosthesis. If you have had or are facing this type of amputation, it’s important to understand that your rehabilitation process will be slow and gradual. Positive outcomes are the result of a strong working relationship between you, your prosthetist and your physical therapist. Another key factor is having a prosthesis with a comfortable socket, such as Hanger’s anatomically correct socket for HD/TP. For more information on this socket, click here to visit the Lower Extremity Prosthetics Program section of this site.
High-level prosthetic users encounter unique lifestyle issues not faced by other lower extremity users. Areas of special concern are quite personal and include: using the bathroom; weight control and physical fitness; being comfortable at home; and pregnancy and childbirth.
The fit of the HD/TP socket can make using the bathroom cumbersome. Men do not have to remove their prosthesis to urinate, but women sometimes do if their socket crosses over the midline. For both men and women, it is usually necessary and more convenient to remove the leg for a bowel movement. It is not unusual for a person with an HD/TP to have had a colostomy. If you are in this situation, the socket will be designed with a hole that allows for the stoma to exit the socket and connect to the collection bag. On the inside of the socket, a small ring of soft plastic will extend out from the stoma, spreading the weight-load and preventing pressure in that area.
Finding the right undergarments can be difficult and many people end up creating their own undergarments from cotton or spandex. Ready-made stockinets and socks are also available and some people like one-piece unitards. Another option is to modify bicycle shorts by trimming off the length on one side and sewing it shut. Since the socket wraps snuggly around the waist, many people have rolls of soft tissue around the top of the socket. Therefore, you might prefer undergarments that extend above the socket as they help protect the soft tissue from being pinched or chafed.
As an HD/TP user, weight control is especially important. With a socket that encompasses your abdomen, excess fat can lead to an uncomfortable fit. Carrying extra weight also puts stress on the residual muscles and on the entire sound leg, especially the joints. Walking on a HD/TP prosthesis is quite difficult and being overweight makes it more so, reducing your energy and stamina. And remember…even for those who maintain a healthy weight, HD/TP users require up to 200 percent more energy to walk than the average person. As outlined in the previous “Healthy Lifestyles” segment, it is critical for you to control your weight by following a healthy diet, and including exercise in your daily routine. The strength you build when you commit yourself to being physically fit will also lead you to real mobility and success in your day-to-day activities.
HD/TP users also have special concerns related to their skeletal system, particularly the back and spine. The normal muscular-skeletal attachments have been disrupted by surgery and this can lead to the development of scoliosis or abnormal curvature of the spine. TP amputees are most vulnerable as they have lost half the muscle and tendon attachments that held the back straight. HD/TP amputees should be examined for scoliosis on a yearly basis; the earlier it is detected, the better the chances of preventing it from worsening. Ask your prosthetist about creating a “sitting socket” that you can literally sit on when you are not wearing your prosthesis. Sitting sockets help distribute weight and pressure more evenly over the entire residual area, reducing the tendency towards scoliosis and back alignment problems. Sometimes an orthotic back brace is also recommended. A sitting socket is critical if you use a wheelchair all or part of the time, and is also good to have if you participate in recreational activities where the prosthesis is not worn. Another useful item is called a pelvic leveler; it is a small foam cushion you can place under the amputated side when you are sitting without a prosthesis.
When you are relaxing at home, you will probably want to take your prosthesis off. Like kicking off your shoes at the end of a long day, it is simply more comfortable to remove the prosthesis, especially when you want to sit on the floor. There is always a bit of risk associated with not wearing your prosthesis. For example, many people will hop around on the sound leg, which is not a good idea for two reasons: first, it puts a lot of stress on the joints and foot, damaging the sound limb; and second, your chances of losing your balance and falling are greatly increased. Instead of hopping, crawl short distances or use crutches to get around the house. And speaking of crutches, don’t assume that any old pair will do. Your crutches must be fit correctly or you’ll develop strains in the arms and hands; crutches should be lightweight and have shock absorbing tips. Some people use a single crutch for added stability when they are walking on their HD/TP prosthesis, and many people rely on a cane for balance.
Women with high-level amputations often wonder if their body will be able to accommodate a pregnancy. It is easy to see why the absence of a hip, or a hip and pelvic bone, might make this significantly more difficult. There are several Hanger patients who have had normal pregnancies and normal vaginal deliveries. This is easier for HD users since they still have the supportive bone structure of the pelvis to help carry the weight of a pregnant uterus. TP users run a greater risk of having a dropped or titled uterus. As the abdomen expands, the socket can be modified, however, it is recommended that pregnant women stop wearing their prosthesis by 20 weeks gestation to prevent putting pressure on the baby. You may prefer to take your prosthesis off at an earlier stage; it is an individual decision. Some women report that a supportive maternity sling that extends under the abdomen can be very helpful.
To learn more about special considerations for HD/TP users, visit hphdhelp.org. This comprehensive website was developed by HP user Christina Skoski, MD. Whenever possible, your Hanger prosthetist will connect you with another HD/TP user for information sharing and support.