~ Part 1
In 2009, five locals each had a limb amputated. While the stigma of living as an amputee is less in 2010 than in 1995, it is no less a life changing experience. This two-part health feature shares the experience of Charles Cannegieter – a senior citizen who is living as an amputee but has a very active and vibrant life. Also covered is much of what needs to be known about the amputation procedure, recovery and the A-Z of prosthetics.
Charles Reginald Cannegieter was born April 2, 1924, on Anguilla. Around the age of 13, he moved to Sint Maarten where has lived for most of his life. As a civil servant, he and his colleagues spent days planting produce like onion, peas, potatoes, yam and cabbage for the government. The produce was collected and sold on island or shipped to Curaçao and other islands. After 62 years as a civil servant, the hobbyist planter retired but kept an active life.
With a mind always on health and a love for nurturing plants and seeing crops grow, Cannegieter, aka Reggie, spent a lot of his time planting at home. Over the years, he has planted and produced many crops of potatoes, pigeon peas, corn, sweet basil, mangoes, coconut, papaya, banana, figs and plantain. With all this planted, his diet has many fresh organic items in it. Currently he lives with his daughter Ruby in St. Peters.
In his younger days, he enjoyed playing cricket and other sports. On evenings and weekends, he would go with friends to different places to listen to people play music. Sometimes he would join in the creation of music but only to play the maracas, as his musical abilities were limited. Cannegieter is a busy person with an infectious positive personality.
One day in late 2005 while working in his garden, Cannegieter scraped the sole of his foot on the rough side of a cement block. Immediately he went to the doctor to have it treated but the wound never healed and became infected; this was due to poor blood circulation in his lower appendage.
Like the average elderly person, healing of the body takes more time and is very taxing on the body. With each day spent in the hospital, the pain in his left leg became more unbearable. At one point, the pain was so severe, that vanity and caring about being a "whole person" were so far from his mind that he demanded the doctor remove his leg. The request was a bold and brave one. The doctor and staff thought of ways to save the leg, but soon conceded and produced to prep Cannegieter for lower leg amputation surgery.
Choosing to amputate is a tango of timing and skill. Whenever the possibility of having to do an amputation arises, there are a few things that have to be taken into consideration. The goal is always to save as much of the affected limb as possible. Staying below the elbow or knee is always favoured. When the knee is spared, the patient can better stabilize himself.
Also to be considered is the patient's mental and physical state of health, especially for older patients. Cannegieter was in good physical health and was accepting to have part of his leg removed. Needing only a lower limb amputation combined with his positive attitude would mean that his recovery and return to normal activities would be smoother than if he was against the surgery. The result caused Cannegieter's family and the medical staff to call him a "model patient."
About amputations
There are different reasons for needing amputation. In Cannegieter's case, poor circulation prevented his wounds from healing. Other factors like diabetes sores (caused by small mosquito bites not healing and causing infections), trauma (incurred from a debilitating accident where the bone is shattered beyond repair) and poor circulation (sensitivity to the foot is still intact but the blood is not flowing smoothly to that area of the body, usually to the extremities which are further away from the heart) can call for appendages to be partly removed.
Deciding quickly if amputation is the last and best option is necessary. The spread of infection can cause serious health problems and make the rehabilitation process more difficult. When having to do an upper limb amputation, the cost of prosthesis is higher. The level of mobility is also impaired; relearning to walk, or stand is more difficult. Body weight is also an issue; because most diabetic persons are also obese, the extra body weight can cause difficulties with walking and stabilizing themselves. It also calls for the prosthetic to work harder and may therefore have to be replaced more often. Even though the limb is removed, amputees must still live cautiously, the probability of falling or re-injuring yourself is still present. Double amputation is an even more traumatizing and complex situation.
During surgery, the operating surgeon tries his best to make the end of the stump even and smooth so that it will better fit into the prosthesis. The presence of excess fluid and unhealed stitches in the limb means it is not immediately fitted for a prosthetic. However, during this time, the patient can train with a temporary prosthetic and do other therapeutic physical activities.
After his operation, even though he was in good health otherwise, Cannegieter spent some time in the Sint Martin Home in St. Johns Estate so he could receive round-the-clock nursing care while his stitches healed. While many older patients tend to become dependent on nurses and family members, Cannegieter was out and about hopping on his one leg and being active. His positive mind set and the supportiveness of his family helped his recovery period to be faster. With training provided by Petra Peut, St. Maarten White and Yellow Cross Foundation physical therapist, within three weeks, Cannegieter was walking with an old prosthetic leg of a past patient. After one month, his stitches were properly healed and he was ready to be fitted for a leg of his own.
About prosthetics
Used to replace or restore human body parts in order to regain the lost functionality of the missing part, prosthetics are available for almost every body-part and for just about every condition. Amputees benefit greatly from prosthetic limbs, which help them to regain the ability to walk or use their hands. Women who have had a mastectomy can benefit from prosthetic breasts in the form of implants. People with bad hips or knees can have these replaced with prosthetic alternatives and enable them to get up and moving again. Even prosthetic heart valves are available. Much research is put into the choosing of materials and designs of modern prostheses.
For the creation of artificial legs, the use of stainless steel and silicone padding helps increase the possibility for function, customization options and comfort. Mainly patients make their choices based on the need for stability or mobility. Usually younger amputees choose for mobility because it better suits an active lifestyle and they have more strength to stabilize themselves. Because of their increased risk of falling, older amputees are recommended prosthetics that focus on stabilizing them, even if they have more active lives. Most prosthetic feet can be worn with regular store bought shoes.
Every prosthetic is custom made. For amputees on St. Maarten, every month a specialist from Curaçao comes to make mould of the "stump." This special mould is made of plaster of Paris. If all materials and tools were present, a complete prosthesis could be made in a few hours. However, with the local unavailability of the special oven (no waiting list) it takes a few weeks before amputees could receive their new limb.
However, for special patients, an event prosthetic can be made to be worn with heels, motion sensors (diabetics) and even advance technology that aids a robotic foot to use the same walking pattern as the remaining foot.
Prosthetics help people regain control over their lives and the ability to do things for themselves. In part two, more information about dealing with the psychological effects of having done an amputation, the cost of prosthesis, maintenance, customizations options and more will be shared.
