By Alexander Germanis
When a house is ablaze, the firefighters’ primary goals are to save lives and save the structure to the best of their ability. Although it may be easier at times to simply let the fire consume the house and then build a new structure atop the ashes, few families wish to see that which they call home go up in smoke.
Doctors are likewise dedicated to saving lives and, more specifically, the structure of the body. While it is true there are some cases when losing a limb might, in fact, preserve one’s life, to not first do everything possible to save the complete structure of the body is as James B. Williams, MD, puts simply, “a big deal.”
With Dr. Williams’ three-plus decades of experience in and out of the operating room, he has witnessed the myriad problems and difficulties that can result from amputation of a lower extremity.
Now, Dr. Williams is on a crusade of sorts to not allow his patients to simply give up and give in when facing the choice of amputation. In short, Dr. Williams always wants to leave his patients with a leg to stand on.
A lifetime of experience
Earning his medical degree from Baylor College of Medicine in Houston, Texas, Dr. Williams filled his residency at the University of Alabama Hospital/Clinics. Since then he has practiced medicine in four other states before coming to Peoria in 1999 and forming Cardiac Thoracic and Endovascular Therapies, S.C. (CTET).
Aside from the four CTET locations in Peoria, Princeton, Peru, and Streator, Dr. Williams also operates at four hospitals in the four cities.
Board certified in thoracic, vascular, and general surgery, Dr. Williams is more than aware his stance on saving his patients’ lower extremities may seem a bit out of place. “Why would I, in the last years of my career, focus so extensively on limb salvage?” he postulates.
“After all, companies make artificial limbs, long pants, and portable motorized devices to move a person from point A to point B, so what’s the big deal?”
“Losing a leg is a big deal,” he answers. Beside the risks associated with amputation, there is the mounting post-surgery cost of living, often a drastic change of lifestyle and, of course, the need to learn how to move “from point A to point B” all over again.
Why risk it?
Although the loss of a limb is considered a nightmare to most people, there are some who will elect to remove a leg due to a number of medical issues: arterial disease, severe injury to the bones or muscle tissue, thickening of nerve tissue, etc. Amputation of a leg can lead to risks perhaps not realized.
Aside from a literal shortening of one’s stature, lower limb amputation can shorten a person’s life. “If amputations occur for reasons other than cancer or trauma (i.e. diabetes, arterial or venous obstruction (ulceration), median survival is 3.2 years compared to 20 years for the population with both legs,” Dr. Williams states. “After loss of a second limb, mortality is another 38 percent at two years, and 61 percent by five years. This survival is worse than for cancer.”
One of the reasons amputation of a lower limb can lead to a reduced life span could be due to inactivity, the doctor says. While leading an active lifestyle without a major extremity is certainly not unheard of, it is probably far more common for an amputee’s exercise regimen to suffer a drastic reduction. Lack of regular exercise can and will lead to a number of health issues such as obesity, heart disease, and cancer.
The striking mortality increase is also probably due to another major issue as well, the doctor adds. “We know, for example, that limb amputation from atherosclerosis is also associated with coronary artery disease.”
A common condition in the middle aged and older, atherosclerosis is a hardening and narrowing of the arteries due to a build-up of things like fat and cholesterol.
Pain in the pocketbook
Anyone who has ever needed to stay in the hospital knows just how expensive health care can be. That cost can quickly skyrocket when whatever health problems one might be enduring are lasting or chronic issues. What, then, is the amputation of a lower limb if not a chronic health issue?
If one wants to return to a normal existence after amputation, one will first be looking at bills or insurance hassles well past the hospital stay. “The cost of an artificial limb varies, according to material used and expected functionality,” says Dr. Williams. “For example, an entirely titanium limb made for jogging can be quite expensive, while older materials, with use purely for balance or cosmetics, not so much. A limb costs between $5,000 and $50,000, with most costing someone somewhere in the middle — about $20,000 to $25,000 dollars.”
If one is hoping for insurance to pay for it, Medicare, the doctor states, actually will cover most of the expense while creating the least amount of trouble. Private insurance carriers, in the doctor’s experience, can be very difficult to work with. “They throw up many barriers to timely payment to the people who construct these limbs,” he says.
Aside from the pain, the cost, and the insurance hassle, there are numerous issues one still has to deal with after an amputation. “Many daily perceptions and routines change for an amputee,” Dr. Williams says. “First and foremost is body image. People with one limb see — and frequently feel — themselves to be significantly handicapped. Feeling that you look different doesn’t help with truly functional matters associated with living.”
Some of those matters are so common that most people would not realize how important they are until they cannot perform them anymore. “How do you drive a car with one leg, especially if your right leg is lost?” Dr. Williams asks. “Gas and brake controls are made for right legs.”
“How do you get into your house if there are stairs to contend with?” he continues. “Or into your shower or bathtub? Once you are in a tub, how do you get out?” Furthermore, transportation with a scooter, a wheel chair, or any other motorized aid also becomes an issue.
“All of these activities require structural modifications to your car or home, such as ramps, lifts, and special controllers (for cars); for bathrooms, toilet modifications and other modifications such as rails are required,” the doctor lists. “These require planning, expertise, and of course pose additional expense. Once again, who pays? These modifications are typically out of pocket.”
Learning to walk
Walking is one of the very first things we learn. Most children learn how to walk before they learn how to speak. To be able to move around independently is something upon which we rely from the earliest of our days. Therefore, the need to learn how to do so once again can be a trial.
“Walking with a prosthesis requires strength and the expenditure of more energy,” Dr. Williams says. “Walking will require physical strengthening, balance and gait training, and may require use of a cane, crutch, or walker. Learning how to walk will require some time in rehab.”
Rehabilitation may be more than a physical trial, the doctor indicates; it may be a trial of the mind and spirit as well. “Walking again may not be possible for as many as half of all new amputees. The closer to the hip the amputation occurs, the less likely one is to walk on a prosthetic limb,” he says.
The length of time before one can even be ready to move again varies. “It depends upon many things, but most importantly on wound healing and the presence or absence of phantom limb pain,” he says. “Healing takes a minimum of three months and may take up to a year or more. The presence of pain in the amputated limb is highly variable, but if not managed, can prohibit use of a prosthesis altogether.”
Look before you leap
“All of the above mentioned issues are, of course, surmountable,” Dr. Williams admits, “but as one can see, to avoid these issues — frequently in the last years of a patient’s life — is highly beneficial to patients. Of course, without question, it is better to save a limb than to simply ‘cut it off.’ Listen to me. Please. For the most part, you, the patient, are in control.”