Prostheses: A Patient’s Perspective
- By Trudie Mitschang
AFTER LOSING HIS arm in a freak accident, RobertDoty, MD, became actively involved in educating and providing support for people with upper limb loss, in addition to advocating for prosthetic parity at the state and federal levels. Dr. Doty served as the chair of the UpperLimb Loss Advisory Council for the Amputee Coalition of America.
BSTQ: Tell us about your background.
Dr. Doty: I am a physician who spent 30 years in practice. My specialty was emergency medicine, so trauma was not an unfamiliar occurrence. However, I did not expect to experience trauma of my own. When a hydraulic lift holding a car above me failed, gravity took over. As two objects cannot occupy the same space at the same time, and the car had considerably more mass and inertia than me, I was, quite literally, dealt a losing hand, including a wrist and partial forearm.
BSTQ: What happened at the hospital?
Dr. Doty: After battling the car for hours, I managed to get loose and find help. While I was being treated at the hospital, a deputy retrieved my arm from the site, and we were flown to another hospital where a surgical team reattached the arm during a 22-hour surgery. This included reconstruction of the radius, but the ulna was too badly damaged to reconstruct. (The radius and the ulna are the outer and inner bones of the forearm, respectively.) The cut through the arm was relatively “clean,” but the impact of the brake disc and wheel assembly had shattered the bone above the amputation.
BSTQ: What led to your decision to amputate?
Dr. Doty: I underwent treatment, including extensive physical therapy, several orthotics and continuous passive motion machines. Though the hand remained, there was no functional nerve return, sensory or motor. Worse, with a useless hand and a weak, painful wrist, I couldn’t use the remaining portion of the arm and shoulder, so they also were wasting from disuse. I was considering a series of surgeries, but the likelihood of any sustained improvement was remote. Finally, with the insight and agreement of my orthopedic surgeon, I underwent a therapeutic amputation. Suddenly, what had been a painful, disappointing and frustrating period of my life began to improve dramatically.
BSTQ: How did getting a prosthesis improve your quality of life?
Dr. Doty: With my prosthesis, the list of things I could do again was staggering. Most significant by far were the improved ability to feed and dress myself, drive, tie knots, open containers, use tools and take care of my home. I also wasted less time having to wait for someone to help me. Although my prosthetic hand could never give me the function I had before the injury, it was light-years ahead of anything I could have hoped for with the reattached arm and hand.
BSTQ: Tell us about your work with amputees.
Dr. Doty: Since being thrust into the world of amputation and prosthetics, my learning curve has been steep, but interesting and enlightening. I have met and worked with many amputees, occupational therapists, prosthetists and others in thefield. I’ve participated in and led a number of presentations, seminars and lectures.
BSTQ: As a physician, what challenges did you recognize in the medical community regarding this topic?
Dr. Doty: I think doctors struggle to avoid focusing on the specific injury or disease and can lose focus on the patient as a whole. This tendency has worsened with the development of specialties and subspecialties. Doctors tend to feel we have failed or given up on our patients. Of course, this is not always possible or rational. Doctors also have difficulty giving up the battle and moving on if we experience some initial successes. This not only exhausts the doctor’s resources, but more importantly, the patient’s.
BSTQ: Are insurance considerations a factor?
Dr. Doty: If the surgeon knows insurance will pay many times over for serial surgeries but will not cover the patient for far less expensive prosthetic options, it can influence the decision process.
BSTQ: What about statistics regarding patient noncompliance?
Dr. Doty: A number of poorly understood statistics sometimes deter surgeons in upper-extremity cases. One stat is that 50 percent of upper-extremity amputees with prostheses don’t wear them. This is certainly not what I’ve experienced. In some cases, patients may not have the experience or knowledge to recognize a poorly fitting or nonfunctioning prosthesis. Patients may give up, thinking it’s their fault, or they may give up because no one knowledgeable counsels them. It is essential for upperextremity amputees to follow up with a prosthetist experienced with their level of amputation.
