PROSTHESIS AND QUALITY OF LIFE

Jenny was a 74-year-old bilateral below the knee amputee due to a significant history of peripheral vascular disease (PVD). She moved around in a wheelchair and had a prosthesis on her left lower leg. She used her prosthetic leg to transfer to and from the wheelchair to bed and visa versa. The prosthesis was replaced a little over a year ago costing over $4,000. What holds the prosthesis in place is called a sleeve which consists of similar fabric that is used to support knees and elbows when playing sports or when injured. It is stretchy and when new fits snuggly.

The stump of the leg fits in a socket which was made specifically for Jenny. Measurements were done before the prosthetic limb was made to make sure it fit and there will be no slipping. Slipping of the stump can cause pain and potentially skin breakdown. This could be serious for Jenny due to her PVD.

Jenny started to complain to me about her stump slipping in the sleeve and socket of the prosthesis. She showed me the sleeve and it was obvious the fabric had stretched out over the year. She had no significant weight loss that could cause the stump to become smaller than when originally measured. Jenny also experienced pain on her stump when transferring which caused her discomfort and frustration. As the NP with no real experience with prosthetic limbs I arranged for a company representative to visit Jenny to look at the fabric to see if it could be replaced so her stump did not slip and cause her pain. My heart broke when she told me when she sat in the dentist chair her leg fell off. When I started this adventure I thought nothing of helping Jenny with her stretched out sleeve. I was wrong.

The prosthesis representative came out and measured Jenny’s leg. After weeks of waiting it was determined she needed a whole new prosthetic limb which meant spending another $4,000. All Jenny wanted was to have her sleeve replaced so her stump did not slip out of the prosthesis. She did not ambulate on the prosthesis but did like to transfer with it. To me this was the only quality of life she had left. I personally could not imagine both of my legs amputated and sitting in a wheelchair or in bed all day long for years.

After months of back and forth messages and trying to get Jenny her new sleeve it was determined the insurance company was going to deny the claim and not pay for the prosthesis. I asked the company to reexamine getting a new sleeve which was all Jenny wanted. I was told they could not replace the sleeve because it was not safe. My response was: She is using it now for transferring, how could replacing the sleeve and help it fit snugger not help? After much frustration the insurance company did not cover it and it was denied.

Telling Jenny was one of the hardest things I had to do in my medical career. Her eyes showed helplessness. All I could say was, “I am so sorry.” Unfortunately that probably was not enough.