Amputees and Addiction

[Wayne Renardson]

Andrew:

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 
trauma.  

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. 
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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.  


Wayne Renardson