Academic journal article Journal for the Study of Religions and Ideologies

Medical, Social and Christian Aspects in Patients with Limb Amputations

Academic journal article Journal for the Study of Religions and Ideologies

Medical, Social and Christian Aspects in Patients with Limb Amputations

Article excerpt

Introduction

The major lower limb amputations represent invalidating procedures for patients which will change definitively their lives. We are speaking about the calf and thigh amputations, which in our surgical service are made for critical lower limb ischemia and diabetes. In the United States, 30,000 - 40,000 amputations are performed annually. There were an estimated 1.6 million individuals living with the loss of a limb in 2005.1 The aim of amputation is to save the patient's life and to reduce debility. Part of a limb may be amputated because of trauma, infection (gangrene), burns, frostbite or disease of blood vessels. Removal of a limb may also be required to prevent the growth of bone cancer. However, amputations are not without problems such as thromboembolism from the surgery and prolonged immobilization, flexion contractures, neuroma, causalgia and phantom limb pain. Individual responses to limb loss are varied and complex, and are influenced by a range of personal, clinical, social, physical and environmental factors.

Religious habits help patients to deal with the stress caused by amputation, providing some acceptance of the act of surgery. The suffering of an amputation marks a crisis in a patient's life, a dramatic change in his/her life and "religion does not stand idly by (...) it provides guidance about where to go and how to get there." 2 Understanding spirituality's effects on patients' abilities to cope with amputation is an important component in rehabilitation of patients with limb amputations.

The World Health Organization's primary domains of QoL (quality of life) include (1) physical, (2) psychological, (3) level of independence, (4) social relationships, (5) environment, and (6) spirituality/religion/personal beliefs. Treating the mind, body, and spirit in patients with major lower limb amputation is important to the physical and psychological adjustment to illness and injury. With greater emphasis on evidence based practice in a cost-conscious health care system, health care workers, providers, and leaders of health care must be able to rationalize their actions with evidence generated by scientific research. Spiritual wellbeing in patients plays a significant role in coping with illness and demonstrates moderate to strong correlations with physical, emotional, and functional well-being. 3

Medical aspects in patients with major lower limb amputations

The multiple pathways that may lead to limb amputation include disease (e.g. diabetes, peripheral vascular disease and malignant tumors), traumatic injury (e.g. motor vehicle and industrial accidents) and congenital causes.

The main problem for those patients is to accept the surgical intervention and to sign the informed consent for the amputation. The surgeon establishes the diagnosis and proposes the surgical intervention, as the last option in the treatment of the critical lower limb ischemia. It's not an easy decision and they are consulting the family.

On hearing of the word "amputation", patients would go through stages of denial, anger, negotiation and depression before acceptance, a situation akin to what is applicable to patients who find out for the first time that they have cancer or are HIV positive. In many instances it is this delay in the decision making process that worsens the outcome. Doctors therefore must give prompt and adequate counseling to the patients before they take the final decision4. However in life-threatening situations particularly where patients present very late to hospital, urgent decisions should be agreed upon by patients and relatives to save their life. It is still better to be alive even without a limb. 5

Usually the patients are suffering from pain for a few weeks and if initially they refuse to accept the amputation, finally they are begging the surgeon to perform that, because of the higher pain, fatigue, insomnia, social degradation and starvation. In this desperate situation they accept the amputation only to get away from that gnawing pain. …

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