Residual limb volume changes and travel REPLIES

Residual limb volume changes and travel REPLIES

Eric Kuhl

2/14/2012

Hi list:

First I would like to say how impressed I am at the speed of which I received answers. Though I have responded to posts in the past, this was my first question. A Very good experience, and thanks to all who replied.

Second, this question was generated from a problem I am dealing with now. They are a fairly new amputee in their 2nd check socket, a long T/T amputation. They are wearing an Alpha select cushion liner with a knee sleeve [in future an Ossur X5 is being considered once volume stabilizes]. At the time I asked my question, they were down in Cuba from Manitoba for a week. The number of socks worn before leaving was between 0 and 2 (later in the day), and I suspect that over time they will decrease in volume some more. To properly get it on, they would put 2 liners at once, try wrapping, eventually get to a point were they could get part way in the socket, and walk around for ~10 minutes until they settled in. Within a day of returning home he was fine.

I did find this odd, as my first reaction for volume change would be a loss, as others have mentioned, not a gain.

Thanks again for the replies, sorry for the delay in posting them.
Eric Kuhl, C.P. (c)


Hi list:
>
> I am looking to hear of anyone's experience with transtibial patients who
> increase in residual limb volume when they travel from a cooler climate to a
> warmer one. Typically they start out with a good sized socket (ie 0-2 ply
> fit at home).
>
> I have a few patients who have to deal with an increasing volume size over a
> short period of time. I am wondering if it is not necessarily climate and
> location (ie altitute, humidity, heat) or if it more lifestyle, eating
> differently or drinking more then usual.
>

1)
We see this in FL every winter. Snowbirds, Canadians included, come
down and need their limbs adjusted after a short while.
I know of no study to confirm, but the theory is changes in heat and
humidity increase perspiration, therefore fluid loss. Couple this
with increase outdoor activities and you have a good theory. May also
look at changes in water content (salts, minerals) and the changes in
diet. Down here snowbirds are most often seen flocking at
restaurants.
Would make a great study for a resident.
Morris Gallo, LPO

2)
Eric,
Our guys from Walter Reed who go on ski trips to Colorado from DC typically lose about 5 ply by the end of a week. I think the increased altitude causes dehydration. Hope this helps.
Zach Harvey, CPO

3)
This is a first; there can be some temporary volume increase as a function
of travel and inactivity, but I have not heard of this phenomenon; I see
amputees from various southern and northern states and travelers from other
countries; I typically fit with no socks or nylon sheath - 1ply;
You indicate you have a few patients with this symptom; socket design that
restricts venous and lymphatic return flow can cause oedema; do you record
body weight and measurements to evaluate? Measurements of both lower
extremities including thigh. This will provide helpful information to
determine cause.

    Jan
                                 
Jan Stokosa, CP, FAAOP

4)
As a transtibial amputee, I've always swollen while traveling regardless of climate or diet. My normal daily fit is 5-ply, but hours of constant sitting inevitably lets my limb swell up to a 3-ply fit.

Many TT sockets elevate the stump within the socket while sitting, which creates gaps that can then fill with fluid. Creating reliefs to accommodate the movement of the femoral condyles during knee flexion helps to minimize this.

Pinching of the popliteal area by the creasing of liners and suspension sleeves can also add to swelling by reducing circulation while the knee is flexed.

Things your patients can do to help prevent or alleviate swelling problems:
� Roll down their suspension sleeve during long trips
� Try to stand for a few minutes every half hour
� Put on a thinner sock just before getting in the car or plane
� Extend their knee and put pressure on the prosthesis for a few minutes before standing
� Flex the muscles in their residual limb to help force the fluids out

Regards,
Marcus Boren, CP

5)
I am a prosthetist working in Johannesburg, South Africa which is at
quite a high altitude with a hot and dry climate. I have patients who
travel to coastal towns like Durban and Cape Town regularly. Patients
traveling to humid Durban experience far more fitting issues (larger
volume in residual limb) than Cape Town which is far less humid. It is
my opinion that humidity has a large role to play in these volume
changes. Patients have told me that this increase in volume happens
very soon after arriving in a humid climate.

6)
A couple summers ago we went through a very humid and hot spell in Chicago and I had numerous patients come in complaining of swelling. Since they hadn't changed anything else like location or activity I attributed it to the climate.
Jacqueline Schmit, MS, CP

7)
My personal experience (8 years amputee, 3 years in the industry)

It is change of eating habits, increased sitting, and reduced wear of prosthesis (
on long road trips I'll release the pin from the lock.

The sodium from fast food and soda does it too. Climate is not an issue for me. Hope this helps.

David

8)
I'm a Chopart amputee with a tib tub height prosthesis. I live in Memphis and travelled to the Caribbean a few years ago and went from wearing 7 to 8 ply at home to being too swollen the first night I was there. I recently went just 3 hours away to Nashville and went down to 5 ply. I think it's more the travel than anything. Either sitting on a plane with the various altitude changes or sitting in a car, possibly with altitude changes, and being seditary for hours that causes fluid to pool in the residual limb. My shrinker is my friend, along with massaging the limb, elevating it and icing it. All of those helped me get excess fluid out once reaching my final destination.
Hope this helps.
Rachel Hartsell, CP

9)
Eric, We have had several patients report this. Additionally, patients will report that changes in altitude, ie, coming down from the mountains to the prairie, will change limb size.
Ron Englander, C.P.



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