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Decisions decisions....

Posted , 2 users are following.

ianwt
ianwt

Hiya,

I've got a massive decision to make, life changing in fact and I wondered if I could ask for your opinions.

A little background first.

I'm a 45 yr old Type 1 Diabetic. Earlier this year I had an amputation of the big toe. Unfortunately, I have Osteomyelitis of the next toe along and it will obviously "have to go". I have poor circulation and calcified arteries from about half way down my lower leg, but a good supply just below the knee.

I have been informed that the long term complications associated with just removing the next toe mean a transmetarsel amputation would be better (all the toes and front half of the foot), however I have been told that I require an arterial bypass (along with angioplasty) of the artery to acheive a good enough blood supply to carry this out. The bypass isn't guarenteed to work, and the angioplasty is awkward as it's through the ankle joint. The added long term conditions with a transmet' have led me to seriously think about a below the knee amputation (this is what will happen if the other operation or healing has probalems anyway).

I feel that the 3 to 4 month wait and see period I'll go through isn't worth it and that my return to work (I am a window fitter by trade) will be hampered with just the transmet work, whereas if I have a below knee amputation, I will be able to enjoy a "full" and decent recovery into normal life. 

It is worth mentioning that I have been off work for 18 months now due to continued problems I have experienced with both feet (diabetic ulcer on one foot which took a year to heal properly promptly followed by an ulcer on my toe which led to the amputation in the first place).

Of the two consultants looking after me, one feels I should go for the transmet', the other feels I should go for the below knee option (in his words, I'm the "ideal" candidate, young (ish), fit, not overweight and have a positive attitude about the recovery from such an operation). My partner has given me full support during this period and all my friends/family are also giving me support to whatever I decide, but any advice from professionals or people with experience of below knee amputation would be appreciated.

Thanks for reading.

Ian

0 likes, 9 replies

9 Replies

  • EileenH
    EileenH ianwt

    Posted

    My husband used to work in this field, measuring oxygen supply to the skin in pre-amputees to assess if a BK was an option as opposed to an AK amputation and he developed a way to predict if it would heal - because that is the biggest problem. He saw many patients who had had "nibbles", first a toe, then another toe and then half the foot and then a bit more, and both of us always said if we had a diabetic toe we would be requesting the BK option from the outset. Most patients are terrified of losing a leg and hear the "just the foot" bit and think it is better. Practically speaking it isn't - as I suspect you know. The period where you are waiting may allow the blood supply to worsen further up your leg - and even a BK may not work if delayed whereas it may well do so now.

    Only you can make this decision - and it is a tough one I'm sure, but I think you have already got the worst part of the thinking behind you. I have heard of a few people who had foot surgery for other reasons that had left them far more handicapped than when they finally had a BK done. There was a young woman in one of the newspapers recently who had made that decision - one foot had had to be removed above the ankle and she realised the other foot was now more trouble than her prosthesis, would they please amputate the other one. Have you been able to talk to the people who will fit and care for your prosthesis?

    If you have your knee you can make a good recovery and be very mobile. Perhaps he isn't a particularly good role model in other ways but look at what Pistorius has managed with both legs having been amputated.

    However you decide - all the very best.

    • ianwt
      ianwt EileenH

      Posted

      Thanks for your input Eileen.

      I've only spoken to the surgeons who are in disagreement as you've read.

      I'm hopefully going to speak to another patient this week who has had the exact same thing as me, and who has made a good recovery.

      I've made my mind up really, but like the opinions of others to make sure I'm making an informed decision.

      Ian

    • ianwt
      ianwt EileenH

      Posted

      Thanks for your input Eileen.

      I've only spoken to the surgeons who are in disagreement as you've read.

      I'm hopefully going to speak to another patient this week who has had the exact same thing as me, and who has made a good recovery.

      I've made my mind up really, but like the opinions of others to make sure I'm making an informed decision.

      Ian

    • EileenH
      EileenH ianwt

      Posted

      Do please come back and tell us what you have decided - and how it goes. 
    • ianwt
      ianwt EileenH

      Posted

      Will do.

      However in the last two days I've had messages of support etc from an Invictus Games Medal Winner, an amputee marathon runner, people in the same situation, people who's family members have had the same thing, and every single one of them has said bite the bullit, take the plunge and "it's the way forward".

      Still, I might bottle it when it comes to the crunch !!

  • ianwt
    ianwt

    Posted

    So,

    I booked my operation today.

    Definately below knee and it's going to be on the 12th November.

    I'll have to remember to add this group to my phone browser so I can post updates smile

    • EileenH
      EileenH ianwt

      Posted

      All the very best for the 12th Ian - don't go getting any colds in the meantime! 
  • ianwt
    ianwt

    Posted

    So.

    Had the op as planned. 

    Everything went well during the op and post op ( surgically discharged after only 6 days, but had to stay in a few more days whilst some minor essential adaptations were made to my property).

    I woke up looked down and thought........ "I've made the right decision".

    I've had the infections that have plagued my body for the last 16 months completely cut out.

    I've notg gelt this healthy for all that time, but now feel full of beans and get up and go. It's a shame I can't just get up and go !!

    Rehab is going well, I'm killing the physio plan, and have taken on more personaql training to occupy the time, but also to help build upper body strength (it's surprising just how hard it is to push your own body weight around !!).

    I'm waiting for swelling and bruising to reduce to get measured for a prosthetic at Roehampton, but that's likely to be after Xmas. Which is probably a good thing as I'm likely to do too much and hurt myself if I was left to my own devices.

    Getting used to the new wheels and getting all the support from the NHS, family, friends and local government that I could possibly hope for.

    The only way is forward.

    Nothing is iimpossible.

    Ian

     

    • EileenH
      EileenH ianwt

      Posted

      That is brilliant news Ian! Especially the bit about the feeling so well. I remember my grandfather being in hospital for months before he died - he had a gangrenous foot but the surgeons felt he was too ill to survive the op and wouldn't amputate. That was 50 years ago - and in the meantime they have realised that in fact the being ill with these elderly patients is more the toxic effect of the gangrenous tissue - take it away and the patient will often get better. It is so interesting to hear that even the early stages you had made you feel ill - but it is always the same, you don't know how ill you were feeling until you suddenly feel better!

      Roehampton eh! Nothing but the best! Though Dundee has an amazing unit too.

      All the very very best - what a celebration you'll be able to have at xmas!

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