Last week, we started the story of Charles Reginald Cannegieter, a local amputee who is living a vibrant, independent life. The final part of this article continues his story and covers related topics of mental state, recovery, cost, maintenance and insurance.

In 2005, while working in his garden, Charles Reginald Cannegieter incurred an injury to the sole of his foot that infected the lower part of his left leg. Adjusting one's mental state to comprehend and accept the changes in one's physical appearance, emotional and social standing is a great task.

The need for amputation comes for various reasons: 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).

While, about 10 years ago having to lose a limb created more negative social stigma than currently, there's still vanity and pride to overcome. When it was time for Cannegieter to make his choice, he said, "There was too much pain to worry about vanity... the leg had to go." His former physical therapist, Petra Peut commented that having a positive attitude and being in favour of the surgery help patients cope emotionally and are also linked to their mobility rehabilitation attitude.

Doctors and social workers play a major role in helping patients make the choice to have surgery and rehabilitate afterwards. However, more important and needed is the support and help from family members and friends. With positive words, patients are less ashamed to use crutches, wheelchairs, prosthetics and other mobility aids.

Recovery

Considered a "model patient" by medical staff and family members, 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. Now almost five years later, he is still very active attending social events, playing with grandchildren and tending to his very fruitful garden.

After surgery, the most common general complication associated with amputation is infection. Even with modern sterile techniques and antibiotics, infections can occur, so good wound care is critical to successful healing. Ice packs are sometimes applied to the operated area over your bandage to reduce swelling and pain. Attacks of the infection on the body are so strong they take a lot of energy to fight them. After the surgery, patients usually perk up because the pain is gone and the body feels less stressed because it isn't using precious energy fighting the infection. Some patients may be wheel chair bound for a while. However, generally, patients are encouraged to get up and move about as early as the day after surgery.

Sometimes (usually in the period directly after surgery), patients may experience phantom pains. Phantom pains are heavily related to the mental state the patient was in when he decided to have the needed surgery done. If the patient did not come to grips with the situation and was doubtful about the quality of life after surgery, then pains of loss will be great. Sometimes it can also be that patients have not mentally adjusted to the fact that a body part is no longer present and can set themselves to stand or walk and fail if they are not properly equipped with the support of a cane, walker or prosthesis.

Because of how the body works, physical recovery for younger patients is quicker than for older ones. However, the longer patients stay in bed, the longer it takes for them to recover and the more debilitated they become. Thus, it is vital to get up and start moving around as soon as possible.

Cost

While the materials used to create the prostheses can be bought in many stores and from many suppliers, they usually originate from a large production factory in Germany. As stated before, the prostheses themselves are custom made. The cost of research, testing, production and raw material is counted up to calculate the cost of a prosthetic limb. A basic lower leg prosthesis costs about NAf. 4,800. An upper leg prosthesis is almost double in cost because it uses more material and the technology used to duplicate the function of the knees is costly. Also calculated separately is the silicone liner that goes between the "stump" and the prosthesis; this costs around NAf. 1,000.

Special requests like water proof liners, skins and computerization can also increase the cost. Persons with limited mobility may incur cost for a few home adaptations. With still a great deal of mobility on his own and strong mental state, Cannegieter only needed a few physical adjustments done to his home to better accommodate himself. He put in a shower seat and raised his toilet. He also owns a wheel chair, but hopes he never has to use it.

Maintenance

On average, prostheses can last around five years before padding or other parts need to be replaced. The silicone lining that is placed around the stump is replaced yearly. Persons who enjoy swimming or fishing may experience some rusting to parts because of the exposure to salt in the water. The prosthetic of younger persons who run or do other physical activities many need more frequent replacing or repairing, but this too is covered by the insurance.

The first prosthetic received is a basic one. This basic prosthesis is used to help relearn walking, standing and other skills. During this year, doctors and therapists monitor the patient's lifestyle so that they can better make customization suggestions for the more permanent one.

Insurance

All legal residents are entitled to health insurance of some form. Here on the island the AVBZ covers the cost for the purchase of prosthetic and the required physical therapy needed to help patients become mobile and active again. While it doesn't cover the cost of super high-tech prostheses, it does provide patients with good quality prostheses customized to fit most lifestyle needs. Patients should contact their healthcare insurance provider for more details and information on the scope of their specific policy.

As with everything, there are exceptions or those simply with bad luck. Not every amputee can be fitted with prostheses or regain lost mobility. This may be due to additional physical or mental impairments. The wearing of prostheses on a limb with severe circulation problems, ulcers or extreme loss of the range of motion may not be beneficial. Mental diseases like Alzheimer's or brain damage incurred during the accident, disallowing for patients to relearn motor skills, are also reasons for them not to be fitted for prostheses. However, if there is even the slightest possibility of fitting a patient with prostheses, even to help with transfers or to wear in therapy sessions, this is always discussed between the patient and the rehabilitation physician, the orthopaedic instrument maker and the involved physical therapist, before the patient is fitted with the prosthetic leg. Sometimes even a cosmetic leg is fitted for patients that cannot walk at all, just for the pleasing look when sitting in a wheelchair, so it seems that the person has two legs (to go out or to go to church). This type of prosthesis is not functional, just cosmetic.

Remember the loss of a limb is not the end of the world; there are options and means to improve the quality of life for amputees. Try always to keep a positive attitude and try as much as possible to train and do things on your own. The longer you stay in bed, the longer it will take to recover.

These days, Cannegieter doesn't do much sporting but that doesn't mean he's home sitting around all day. As a very active person, at some point in the day he will be found working in his garden or walking around his neighbourhood. He regularly shares what he grows with people he meets. His positive, cheery attitude and constant walking around are sure to give him enough exercise and the proper mindset to live a long, enjoyable life.