I’m still standing: Rosalea's story
Going through an amputation is not what anyone wants. It is only ever used in order to save the body from spreading infection. Rosalea’s experience all started at the beginning of last year when she noticed a part of her big toenail sticking out, so she clipped it. She must have unwittingly snipped the skin because before long she discovered an infection brewing under the nail. Antibiotics were prescribed, and she had twice-weekly appointments to get her wound dressed, as well as appointments with a podiatrist.
But she and her team could see the toe wasn’t healing as it should so she started going into her local hospital, Kenepuru, for further checks twice a week. Rosalea estimates her medical team trialled between eight and 10 different antibiotics over the next six months, one after another, in the hope that one would deal with the infection. This is all while she was working full time and on her feet all day as a door greeter at Mitre 10, Porirua.
A TRIP TO ED
A month later, Rosalea found herself at the emergency department. Her body was retaining water, which presented itself in a number of ways. Her legs became extremely swollen and blistered, and were constantly weeping. Known as oedema, excess water indicates worsening heart failure due to fluid build-up around the heart. Two weeks later, she was discharged, monitored from home, and visiting a podiatrist in the hospital to continue getting her toe dressed. A district nurse also came a few times a week, taking photos to send back to the vascular team at Wellington Hospital. Unfortunately, they discovered that the infection had progressed on to gangrene, and she was advised to be brought back immediately. ‘I saw the message to ring them. It wasn’t until I got home after five that I checked my phone. I thought, I’ll ring them first thing in morning, but a few minutes later I saw the district nurse coming down the drive. I was in the middle of cooking dinner and everything was left on the stove, but she said, “You’re going in to hospital to have your toe taken off. I’m ringing an ambulance now.” I packed a nighty and two pairs of knickers.’
After the surgery, the wound looked like it was healing well. Rosalea wore a special boot that had packing around the wound, and the doctors seemed satisfied with how it was healing. She didn’t know this at the time, but this was the start of a five-month stint in hospital. Barely half a week had gone by when she was faced with bad news that her neighbouring toe had picked up the infection and would have to come off as well. ‘They came back the next day and said, no, it’s not working. It had died overnight.’
The doctors had discovered that the veins around the toe were calcified and that there was no blood flow to the foot. The only option was to amputate further to a point where the blood was flowing. A week and a half later, Rosalea was back in surgery, having a transtibial amputation.
BELOW THE KNEE (BKA) TRANSTIBIAL
Rosalea stayed in the surgical ward for two months. She then spent a further three months in Kenepuru for rehab, re-learning, and practising how to move herself around a typical living area. She was a quick learner, working with her physiotherapist to strengthen both legs, as well as her core. The occupational therapist also gave her training in transitioning from a wheelchair to a bed, to a toilet, to another chair, to a shower, and back and forth from an electric wheelchair. She was expected to be able to do 50 consecutive ‘lie-down and stand-ups’ before being okayed to go home. ‘It was good. Before I came out of the hospital, I was doing everything myself. I always showered myself in the hospital. And I always transferred from the bed onto the chair by myself. A lot of the time I had the nurses there in case I needed help, which I did a few times. Once they were certain that I could do it myself, I’d get up in the middle of the night and get out of bed, into the chair, go to the bathroom, back in the chair, and back to bed.’
Rosalea laughs when remembering the struggles she first encountered. ‘The most frustrating part of the hospital was not being able to pull up my own knickers! And boy, did it frustrate me, until I figured out a new way. I didn’t have the strength in the other leg to hold myself.’ She had to learn a whole new way of transferring her body weight from one place to another, all while keeping balance.
THE JOURNEY TO RETURN HOME
Before Rosalea was discharged, she and her occupational therapist, physio, and social worker visited her home together, making sure everything was suitable for her altered mobility. The housing trust she rents from, Te Āhuru Mōwai, built a ramp to her front door and also has plans to turn her bathroom into a more accessible ‘wet room’.
Rosalea was given further training in how to transfer from the wheelchair to the shower and back again. She wasn’t going to be discharged until everyone was 100% confident she was safe in her home. A personal medical alarm was also organised, and care agency Nurse Maude was set up as her provider for all nursing and homecare services. Two of the carers already knew Rosalea, even before they had met her. All her years being the first face customers saw when they walked in the door at Mitre 10 made Rosalea highly recognisable by most people she came across, both in the hospital and out of it. One of the carers reckons I’m a celebrity!
‘Nurse Maude is so good. Really helpful, and nothing is too much for them. They come in four times a week to help shower me. Then two nights a week to get my washing in and do any food prep I want. Then every second Wednesday someone comes in to do housework. ‘I have a chair over the bath, so they have the shower on and bucket it over me. But, you know what, it works, I get washed. They do myhair. They are so good!’
PREPARING FOR A NEW LEG
As soon as the final scab fell off, Rosalea was issued a ‘stump shrinker’: a small stocking designed to encourage the swelling to reduce and shape the limb ready for a prosthesis (artificial limb) to be fitted. A stump continues to change in size as it heals, and over time a patient may need a smaller stump shrinker. Starting from an hour a day, Rosalea is increasing how long she wears it by one hour a day until she can comfortably wear it from the time she gets up until she goes to bed. Once that goal is reached, she will be sent in a taxi to Wellington hospital and fitted for a prosthetic by Peke Waihanga – Wellington Artificial Limb Centre.
Rosalea is excited about learning how to walk with her new prosthetic but has kept her mind free of expectation. ‘I haven’t asked how long it will take to get used to it because everybody’s different. I might get on, and it might be easy for me. Or I might get on, and it might be hard. But I’ll keep pushing and I’ll get there.’
This determination is what’s kept Rosalea’s spirits off the floor during the whole ordeal, knowing she needs to retain her sense of humour to make it through. ‘I’ve had a lot of ups and downs. But most of the time I’ve been smiling. I did go through a stage when I was crying, but I’m very determined and I think a lot of that is what’s got me through.’
With that stubbornness, Rosalea says she has plans to return to work, not in her flash new electric wheelchair but on foot, ‘once I get my new prosthetic and I learn to walk again. I’m only going to work on the Saturday and Sunday, which are the busiest times.’ Rosalea knows in which aisle every tool, adhesive, and fitting is in the large hardware store. ‘I tell people where to go. I know where everything is. And I’ve met so many people in the hospital who know me. I might go back for six months or a year. See how it goes.’
Gangrene usually affects your extremities and can occur as the result of an injury, an infection, or an underlying condition – such as diabetes – that affects your circulation. It develops when the supply of blood to an area of your body is interrupted. Tissue that has been damaged by gangrene cannot be saved. If left untreated, it can lead to amputation, organ failure, and even death. But only 15%–20% of patients will need an amputation if treatment is started early.
OUR ADVICE:
High blood glucose levels can damage your blood vessels and the nerves to your feet. This can cause poor blood flow and loss of feeling (neuropathy) in your feet. This means that your foot will be numb in places, so you don’t notice when you have hurt your foot. It can lead to sores that are hard to heal and may lead to amputation. The good news is that many of these foot problems can be avoided by daily foot care. Follow these steps to help prevent foot problems.
• Wash your feet every day.
• Dry your feet and don’t forget between your toes. If your skin is dry, apply a moisturising cream daily but not between the toes. This can increase chances of tinea (athlete’s foot).
• Be careful with heaters and hot water bottles – if you have numbness, it could cause you to burn your feet and not realise.
• Check your feet daily. Use a mirror or ask someone to help. Look for changes to your skin. Cover any cuts or blisters and change the plaster each day. If it does not start healing or gets red, sore, or smells, see a doctor straight away.
• Cut toenails straight across and do not make them too short. File sharp edges. Nails are easier to cut after being washed.
Looking after your feet every day helps keep them healthy. Good foot care, managing your blood glucose and cholesterol levels, eating healthily, keeping active, and stopping smoking can all help stop foot problems and leg amputations. Visit your podiatrist regularly and have your feet checked by your doctor or nurse at your next visit, even if you are visiting for a different reason.
ADVICE FROM AMPUTEES FEDERATION OF NEW ZEALAND: