William Fahringer and Christopher Gorrell, PT, DPT
In 2005, William Fahringer tore his meniscus – the piece of cartilage that acts as a shock absorber for the bones that come together to form the knee -- while working as a plumber for the School District of Philadelphia. What seemed like an easy surgical fix began a cascade of issues that would change his life forever: he underwent 14 procedures in his leg, three knee replacements, and extensive nerve damage, all of which eventually led to his right leg being amputated in 2009.
Today, with the help of a prosthetic leg, he referees basketball games seven days-a-week and has shifted his priorities to focus as much as possible on his wife, children, and grandchildren. His new life and contagious sense of optimism offers a lesson in hope for the patients who came together at a recent meeting of the Good Shepherd Penn Partners (GSPP) amputee support group.
Not every day is easy. Fahringer says the pain associated with his amputation sometimes “feels like putting your tongue on the end of a battery,” he says that’s a rarity and assures others that there are better days ahead for them, too.
“Life,” he says, “is full of surprises.”
The support group’s meetings typically feature a speaker and discussion on the topic they discuss, then some time for the group to socialize. The group also schedules regular outings, most recently a hosting a bowling trip. They’re planning currently for a trip to a Phillies game, as April is limb loss awareness month.
At their most recent meeting, five patients with amputations gathered to learn how to prevent further limb loss from student physical therapist Caitlin McDonald. Some of the attendees have an amputated leg, some use a wheelchair after having both legs amputated, and all have experienced a different set of circumstances and have something to share.
McDonald outlined disease processes and risk factors, including peripheral arterial/vascular disease (PVD), the obstruction of blood flow to the legs caused by built up plaque in arteries, and peripheral neuropathy, a condition in which nerve damage can cause numbness and pain in hands and feet.
Other important issues, such as the link between diabetes and amputees, and smoking, obesity, cancer, and different methods of preventing damage were discussed.
Among key facts:
- Education for at-risk patients for just one hour can lead to a 70 percent decrease in additional amputations of the opposite limb, compared to those who did not receive education
- 82 percent of amputations are caused by peripheral vascular disease and more than half of these cases are due to diabetes, since the disease can cause problems with blood flow to the extremities
- Among patients with diabetes who require amputations, 85 percent experience a foot ulcer first. That means patients should be on alert for warning signs that can be treated to prevent limb loss.
Patients in the support group report that having an opportunity to discuss their condition with others experiencing similar challenges can provide beneficial new ideas and perspectives, and a sense of shared experience for an issue that can often make patients feel isolated, especially if they have mobility problems.
One of those common challenges is phantom limb pain, in which amputees “feel” pain with an area where a limb no longer exists. The pain can be debilitating and last for years after their amputation – but there are strategies to help patients cope and feel better.
The support group typically brings together six to ten amputees from Penn Institute for Rehabilitation Medicine at Penn Medicine at Rittenhouse and from the surrounding community, to share their experiences and learn from Christopher Gorrell, PT, DPT, who runs the support program, and from each other. The group received a small grant from the Amputee Coalition a few months ago to support this objective.
“Several members have mentioned to me that they know that they heard a lot of info while they were in rehab, but were focused on getting home and not yet able to look at the bigger picture,” said Gorrell. “When they come back for the group, they are able to truly hear some of the other info that we are sharing.”
All former inpatients are sent a monthly mailing encouraging them to take advantage of this group, but any staff, family, friends, current and former patients and people from the community are also welcomed to participate in the meetings. Sometimes those with other disabilities find the information useful and/or can offer support to amputees.
“I really enjoy seeing people come back after they have been discharged from rehab,” Gorrell said. “They are so valuable to the program because they are the people living with an amputation(s) and the things they are able to tell the new patients carry much more weight than anything I have to say.”
For more information about the Penn Institute for Rehabilitation Medicine, please contact Chris Gorrell at christopher.gorrell@uphs.upenn.edu .