What to Expect When You Lose a Limb: A Guide for Patients Expecting or Having Recently Had an Amputation.

What to Expect When You Lose a Limb: A Guide for Patients Expecting or Having Recently Had an Amputation. This booklet is somewhat unsettling, because a directive on the inside cover reproaches patients for not reading the material. This statement sets a negative tone for what follows.

What does follow is information supposedly written for "anyone who is going to have an amputation or has recently had one." The booklet contains nine brief chapters, and I find some fault with most of them. For example, Chapter 1 addresses the history of amputations. I find it difficult to envision an individual who is preamputation or postamputation who would be interested in early guillotine techniques, Ambrose Pare, or the onset of infections, although the final message to the patient is that he or she must play the major role in wound healing. Chapter 2 covers preoperative and postoperative aspects of patient management, with accolades given to the registered nurse. No mention is made of the physical therapist's role in this phase. Chapter 3 is concerned with surgery and addresses levels of amputations. It includes a drawing of a Krukenberg upper extremity amputation that is seldom seen in this country.

Chapter 4 and 5 deal with healing, pain and phantom limb pain. In order to ensure that the patient completely understands the types of pain possible, the authors include a rather grotesque picture of a patient who has a knife stuck in his leg, which is also being hit by electricity and burned simultaneously. To further magnify the torture, the patient's limb is being rotated posteriorly 180 degrees.

Chapter 6 attempts to cover in three pages the myriad psychological reactions to limb loss, truly a herculen task. It falls short of achieving its objective.

Chapter 7 is entitled "Physical Rehabilitation." Here, for the first time in the booklet, the authors mention the physical therapist briefly. The message is that the physical therapist helps in the care of the stump and teaches the patient to walk. This is the only reference made to the physical therapy profession. The authors go on the state that patients who have an upper extremity amputation will work with an occupational therapist. I am disturbed to think that patients are still being split into various segments in the minds of some rehabilitation specialists. This chapter also describes residual limb care, postsurgical dressings, preprosthetic exercises, and prosthetic training and review prosthetic components.

After reading the booklet, I must state honestly that I cannot single out the particular audience for whom it would be best suited. It certainly tells patients--in a superficial manner--more than they need to know, and it excludes the major roles played by physical therapists. Perhaps it is best suited for nurses and physiatrists.