Re: Fw: C-leg statement correction

Re: Fw: C-leg statement correction

Levy, Charles Edward

1/13/2003

An experienced and interested physiatrist might be very helpful.

Charles E. Levy, MD

-----Original Message-----
From: Gary M. Berke [mailto:<Email Address Redacted>]
Sent: Monday, January 13, 2003 12:06 PM
To: <Email Address Redacted>
Subject: Re: [OANDP-L] Fw: C-leg statement correction


I am having some real problems with this discussion. The concept that
these issues may be thrown out on-line is ridiculous! Do we know the
history of this patient, is he a smoker? does he have vascular disease?
diabetes? Aneurism? Clots? Heart Disease? Pulmonary problems? Night
pain? other co-morbidities? To assume that these problems are related to
the prosthesis or amputation surgery is indicative of the level
simplicity that we often approach complex problems, this gentleman needs
to be referred to a vascular surgeon as a primary concern.

Gary M. Berke MS, CP,FAAOP
Director of Prosthetics
CIRS-Stanford
VCE-Clinical Instructor, Orthopedic Surgery
Stanford University



-----Original Message-----
From: Orthotics and Prosthetics List [mailto:<Email Address Redacted>] On
Behalf Of Anthony T. Barr
Sent: Sunday, January 12, 2003 10:02 AM
To: <Email Address Redacted>
Subject: [OANDP-L] Fw: C-leg statement correction


In a message dated 1/12/2003 1:54:01 AM Central Standard Time, to the
Amputee Information Network Listserve, <Email Address Redacted> writes:

I can't walk more than 50 yds. without resting. My stump feels like the
circulation has been blocked.

  Al Pike said:
  This would remain unchanged with a C-Leg. The feeling in your stump
relates to socket fit not knee components.

  Tony Barr said:
  There is no prosthetic device currently on the market today or will
ever be made, at any cost, that can cure the problems that are listed
below. Unfortunately, amputees and some prosthetists often ignore the
likely hood that lack of circulation, muscle instability and
regeneration of nerve endings are most often the culprits preventing
successful and long term prosthetic rehabilitation.Reconstruction
surgery should be considered as a solution.

  Before spending $50,000, amputees, Medicare and other healthcare
providers should investigate the ability to receive proper amputation
surgery before appoving funding alternate high end prosthetic devices
and components.

  The feeling described above of the circulation being blocked is
more likely related to post operative conditions as the result of
guillotine amputation which is the standard amputation procedure
performed today.

  1)The bone is simply transected, leaving an open medulary canal, and
losing intermedulary pressure.The blood pressure flows out.
  2) Muscle attachments are cut and allowed to retract no longer
assisting in pumping blood or controlling the limb.
  3) Often times veins & arteries are tied together to prevent bleeding,
but an artery pumping right into a vein causes stress on the heart.
  4) the bone may atrophy due to lack of loading.
  5) The cut nerve ends will form neuromas if they are not placed in a
scar-free, quiet environment and allowed to restore their gliding
ability.

  There is no prosthetic device currently on the market today, or will
ever be available, that can cure the problems described above and as the
result of improper amputation surgery

  (# 1-5 taken from the script of the recently produced video:The Ertl
Procedure: Beyond the Bridge)

  Tony Barr
  Barr Foundation
  www.oandp.com/barr

  Question for prosthetist professionals:
  How many prosthetists discover and disclose to the patient upon thier
intitial evaluation,, that the stump he has been left to work with, is
less than perfect for delivering long term mobility and pain free
prosthetic rehabilitation?