Amputees and Addiction
renardwc at ctrvax.Vanderbilt.Edu
Thu Mar 25 14:39:50 PST 2004
Welcome back:) You once mentioned it was serendipidous we both
studied literature and had similar amputations. Turns out there is a
lot more that is similar. Addiction is not something that anyone
would want to 'know' about, but sadly there are too many of us who
have been there and do have a bit of knowledge.
I discovered it is not terribly difficult to stop using, but it is
one helluva struggle to prevent relapse. Your struggle is beginning
but with a good support framework, you too will be fine.
I read the responses and recall Linsday and I discussing addiction
years back on SJU. It was done with a degree of hesitation since some
people found it easier to dismiss it as a moral issue or to ignore
the reality of adictive life. A healtthy discussion in an unhealthy
atmosphere is nigh impossible.
Esther's suggestion abnout Amnesty and torture is fact-based. You
might recall my posting this blurb on RSD a few years back. It
appeared on OANDP-L and the original writer, whose name escapes me,
sounded as if he had done his homework. FYI, here is what he said:
Reflex Sympathetic Dystrophy (RSD) Syndrome is a progressive disease
of the Autonomic Nervous System that can follow a simple trauma (fall
or sprain) a break or fracture (especially wrist and ankle) a sharp
force injury (such as a knife or bullet wound), heart problems,
infections, surgery, RSI/CTS, spinal injuries/disorders, or major
It is a multi-symptom condition affecting one, two, or sometimes even
all four of the extremities. It can also be in the face, shoulders,
back, eyes, and other areas as well. It may spread from one part of
the body to another regardless of where the original injury occurred;
and RSD can spread in up to 70% of the cases.(1)
In a small number of cases it can become Systemic or body-wide. RSDS
is an involvement of nerves, skin, muscles, blood vessels (causing
constriction and pain) as well as bones.
ANYONE can get RSDS. There are millions of women, men, and children
across the United States with this disease. It affects women many
more times than men, maybe as high as four or five to one, and
affects all age groups from 3 to 103.(1)
1 - According to a National Survey done in 1998 by the National
RSDHope Group of 809 RSD Patients.
I have done TONS of research on RSD and my residency project will be
on this topic as well (because I suffer from it). For patients with
RSD, amputation IS NOT recommended. It is a contraindication. The
reason for this is that RSD is a progressive disorder and many times
after amputation is done, RSD develops in the remaining stump. It
will then travel because that extremity has experienced excessive
trauma. THIS IS NOT RECOMMENDED.
Furthermore, I have traveled all over to Dr.'s around the country,
and found one that is THE BEST in treating RSD. I can almost
guarantee relief for this person.
My thoughts on this subject are that RSD is a little known disorder.
With the limited research on it, no one can determine the cause or
cure. I have dealt with several patients and a family member that
have RSD, and it is a very difficult task to treat. It is an even
greater task to understand what these people experience. My fear for
your patient is that if an amputation does take place, who is to say
that the disease does not spread. I have had a few patients where
that has happened, and it is even more traumatic than dealing with it
in the first place. Can cause even the strongest of individuals to
slip into depression.
My suggestion is to tell your patient to explore all avenues before
continuing with an amputation.
Encourage the patient to try a course of true elevation of the lower
extremities, by which I mean feet higher than knees, knees higher
than hips, hips higher than heart. This can be done by laying on a
sofa with the head cushion removed and added the the foot area and
try to stay down in this position for an extended time. Most people
with swollen extremities report the feeling of the water starting to
soon flow from the swollen limb. Then other conventional methods of
orthotic support can be tried if this helps, the cost is cheap and
benefits can be very efficient.
I've worked with several RSD patients. First one elected amputation
with no relief of the pain. Watch him go slowly downhill, get
depressed and eventually commit suicide. It was an eye opening
experience and a very sad one. I have not EVER heard of a case of
RSD who elected amputation and had success. I would advise this
gentleman to really research amputation as an elective because it
likely won't help the situation.
I am dealing with a RSD case now and am also in that debating phase.
They are really so different that it is difficult to offer advice. I
was honest with my lady and stated very clearly that my orthosis may
not assist with her pain at all. I say it's just like medicine.
Sometimes it's successful, sometimes it helps a little, other times
it is rendered totally useless.
RSD is a very horrible thing. My advice is to treat the PROBLEM and
not the PAIN. I don't think you'll be successful at reducing the
pain. Don't end up being the escape goat and explain this to your
patient right up front.
NO.. although Dr. Hooshmand and Hashmi have done lots of RSD research
and I am sure are very fine Dr.'s for this disease. I have found one
that I as well as many others feel is the best in the country. He is
at Cleveland Clinic and his name is Dr. Stanton-Hicks. He has done
lots of research and written many pieces on RSD. He also sees
hundreds of patients a month with this disorder. I was on crutches
for five months before treatment through Dr. Stanton-Hicks. Although
I still have lots of pain, I am off crutches and working on P.T. to
decrease the pain and ROM. If you have any other questions or
comments, do not hesitate to call or write.
Please feel free to vent here about your experience with this serious
problem. and also FIY, I gave up my last addiction October 12th.
After forty years of chain-smoking, I stopped. Been five months now.
What a long love-affair that was. Indeed. I want one....right now.
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