You Need To Find Your Own Way To Deal With Stump Pain
Joanna describes her very own ways of dealing with stump pain. Chemical painkillers are only a last resort.
Surviving An Avalanche
Hi, my name is Jo and I’ve been an amputee about 14 years. I lost my left foot and 2” of my left leg in a mountaineering accident in Switzerland in the summer of 2005. Whilst climbing the Taschhorn-Dom traverse, I was caught in an unforcasted storm, benighted, and then avalanched whilst descending the following morning. The avalanche buried me under about a foot of hard-packed snow which set like concrete.
It was move or die so I moved - I managed first of all flex my fingertips and eventually to melt myself out which took maybe five hours: I think the block-like nature of the snow had created an air passage which my fingers found and exploited to create an opening wide enough to eventually shrug myself out.
But at some point the force of the avalanche had snapped off my foot. I was rescued by helicopter 30 hours after falling by which time I’d lost three units of blood. I was in hospital in Berne/Switzerland for a month whilst the amazing surgeon there, Mr. Weber, set about saving as much of my limb as he could.
I’m very lucky to be alive – it wasn’t really a survivable accident. And I’m very lucky that the Swiss Search and Rescue crew flew me into the compassionate care of Mr. Weber. Whilst in hospital, I lost nearly two stone in weight (including however much a size 5 foot weighs) and afterwards was on morphine patches for six months, amitriptyline for a further 18 months and on crutches for nine months.
The Chopart Option For Increased Mobility
I have what is called a Chopart amputation which means that I have retained a load- bearing heel bone and heel pad. However, because of the shortening (the protruding snapped ends of my shin bone became infected and so had to be trimmed, re-joined and re-fused), my amputation presents as a Symes (which is an amputation through the heel bone). Mr. Weber is an advocate of Chopart and Symes amputations because of their increased functionality. I can walk short distances without a prosthesis. Anywhere else, I’d probably have had a Below Knee Amputation (BKA).
I remember being in a great deal of pain for the two years following my amputation; the early break-through pain felt like someone had wrapped red-hot barbed wire around the bottom few inches of my stump and were pulling on the ends to tighten it. It hurt a lot for the 20 minutes it took the oramorph to kick in. The local pain consultant said I’d be on painkillers for the rest of my life but Mr. Weber said after two years the nerves would settle and I’d be fine – and that’s exactly what happened.
My son was born just under three years after my amputation and my stump pain came back in the final trimester. So after toughing it out for as long as possible, I took codeine for the final month of pregnancy. My son was fine and the pain went away after his birth. No-one is really sure what was happening there but maybe it was a combination of increased weight and hormonal changes.
Of Hot Baths, Warm Water-Bottles AndTrusted Bellies
My stump is long and skinny and my main problem these days is the cold. There is reduced vascularity in my stump as my calf muscle has withered (no foot to move up and down) and so once my stump gets cold, it stays cold, and then it starts shouting and then screaming. This shuts me down completely and flattens my battery – a hot bath is the best thing to revive my stump, or failing that, a hot water bottle or a handy belly. I have a small, select group of people who are willing to warm my stump on their stomach during a cycling or skiing café-stop.
Codeine is the only painkiller that touches the cold-pain and even that doesn’t always work. Keeping my stump warm at all times and especially during exercise is the best strategy – a piece of karrimat wrapped around my prosthesis, heat pads, and having a dry, body-warmed stump-sock to change into. Oh, and holidays in the south of Spain.
I also find that when I get stressed, my stump pain increases. I guess this is phantom pain – it’s like pins and needles in my stump with very occasional shooting pains which take me by surprise. Painkillers don’t work well here – I find again that keeping my stump warm is important, and stroking my stump and my undamaged foot at the same time. I think this helps my brain realise what a normal foot response is, and helps it to reset. Exercise really helps – I’m more likely to get phantom pain when I’m sedentary. I’ve also found that chocolate and a nice cup of tea help whilst I’m stroking my stump – no, really!
I have no idea how much pain other amputees feel. The only amputees I know are through the UK BMC para-climbing competitions and when we meet, we talk about climbing and not about pain. It may be that BKAs or trans-femur amputees live pain-free lives, I wouldn’t know. For me, pain is unpredictable and is something that I manage as best I can on an on-going basis - by giving my stump as much love and attention as possible - and by using painkillers as a chemical cosh as a last resort.
Guest post by Joanna Waterton. Joanna is a chartered Chemical Engineer and Process Technology Manager at The Centre for Process Innovation, a partially government-funded organisation which helps companies to develop, prove and commercialise the next generation of products and processes. Outside work, Joanna is a keen climber, cyclist and runner and a member of the British Paraclimbing Team. Much of her energy is spent trying to keep up with her 10 year old son.