Phantom Limb Pain: 2/2

Today, author and Christy Award nominee (two nominations!) Jocelyn Green concludes her two-part series on phantom limb pain. You can find Part I here

As an added bonus, Jocelyn has graciously offered to give away a personalized copy of her latest novel, Widow of Gettysburg, to one commentor. To enter, leave a comment on any of her posts WITH your e-mail address. Must live in the USA. Winner drawn midnight, Saturday, May 11th, 2013 and announced here at Redwood’s on May 12th, 2013.

Jocelyn has also graciously said she’ll send you a signed bookplate if you have any of her novels and would like one. Again, MUST have your e-mail. 

You can view Jocelyn’s previous posts at Redwood’s here and here.

Welcome back, Jocelyn!

What We Know Today

The study of PLP continues with today’s generation of amputee veterans. Most contemporary studies confirm what Mitchell found, but add to it some new information. Most recent studies report PLP at rates of 50% to 80%. A few of these are in constant pain, but for most, the episodes can last a few seconds or one to two hours.
Since the beginning of the conflicts in Iraq and Afghanistan more than 1000 amputees have been treated at Walter Reed Army Medical Center in Washington, DC. Almost all experience PLP, either within the first 24 hours of amputation, or within two weeks. The following insight comes from an article in a 2010 issue of The Neurologist:
“As part of routine treatment efforts, the patients are asked to describe their experience with phantom sensation and phantom pain. There have been a plethora of responses regarding the onset, duration, description, and location of phantom sensations and phantom pains from those queried. Furthermore, some explain they have volitional control over their phantom, and can move their phantom at will, while others report their phantoms being fixed in a specific position. Some even report the inability to make movements with the phantom, despite the presence of a strong sensation or pain emanating from their residual limb. For example, one service member reported that his phantom hand was in a distinct position: he felt he was pulling the trigger on his rifle with his index finger, and was unable to move his hand to a different position. He also felt cramping pains in his hand muscles. Another service member, a bilateral, above knee amputee, described the feeling of heavy legs, asserting that the feeling was similar to weights attached to his calf muscles. He also described that it felt as though his combat boots were on too tightly.”
There are multiple theories as to the cause of PLP, all of which can be read in this online article [http://sunburst.usd.edu/~cliff/Courses/Advanced%20Seminars%20in%20Neuroendocrinology/Pain/Weeks10.pdf]. 
The most successful treatments have been with opioids and mirror therapy, the latter considered the most promising treatment plan.
In this treatment, the patient views the reflection of their intact limb moving in a mirror placed between the arms or legs while simultaneously moving the phantom hand or foot in a manner similar to what they are observing. The virtual limb in the mirror appears to be the missing limb.
Patients have reported a relief of cramping and “frozen limb” phantom pains as a result of even one session with the mirror. In one study in which patients used mirror therapy for 15 minutes each weekday for four weeks, significant decreases in pain were reported. More about mirror therapy can also be found in the online article hyperlinked above.
For further reading:
Mitchell, Silas Weir. The Case of George Dedlow. (fictional account of quad amputee) New York: The Century Co., 1900. Read it online at Google Books here, and begin on page 115. http://bit.ly/ZixtJd
 
Gunshot Wounds and other Injuries of Nerves. Philadelphia: J.B. Lippincott, & Co., 1864. Read it online at Google Books here: http://bit.ly/17hhuvf
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 A former military wife, Jocelyn Green authored, along with contributing writers, the award-winning Faith Deployed: Daily Encouragement for Military Wives and Faith Deployed . . . Again. Jocelyn also co-authored Stories of Faith and Couragefrom the Home Front, which inspired her first novel: Wedded to War. She loves Mexican food, Broadway musicals, Toblerone chocolate bars, the color red, and reading on her patio. Jocelyn lives with her husband Rob and two small children in Cedar Falls, Iowa.

 

Phantom Limb Pain: 1/2

Author and Christy Award nominee (two nominations!) Jocelyn Green joins us again this week for a two-part series on phantom limb pain.

As an added bonus, Jocelyn has graciously offered to give away a personalized copy of her latest novel, Widow of Gettysburg, to one commentor. To enter, leave a comment on any of her posts WITH your e-mail address. Must live in the USA. Winner drawn midnight, Saturday, May 11th, 2013 and announced here at Redwood’s on May 12th, 2013.

Jocelyn has also graciously said she’ll send you a signed bookplate if you have any of her novels and would like one. Again, MUST have your e-mail. 

You can view Jocelyn’s previous posts at Redwood’s here and here.

Welcome back, Jocelyn!

Though the phenomenon of phantom limb pain had been recorded long before the Civil War, it was Silas Weir Mitchell, a Philadelphia physician specializing in nerve injuries during the Civil War, who coined the term. Phantom limb pain, or PLP, occurs when a patient feels pain in an arm or leg that has been amputated. Mitchell studied PLP (or sensory hallucinations, as he also called them) in depth at the Turner’s Lane hospital in Philadelphia, dubbed the Stump Hospital because it focused on caring for amputees.

If a character in your story is an amputee, like one of my characters in Widow of Gettysburg, the following will be helpful to you.
What Mitchell Found
·         Almost every amputee at Turner’s Lane Hospital experienced PLP. 
·         Most of them came out of anesthesia feeling the presence of the amputated limb.
·         Those who did not immediately feel PLP usually felt it within three weeks.
·         Usually, the patients felt the missing hand/foot but not the section of limb directly beyond the stump.
       Mitchell wrote: “The patients describe themselves as knowing that they have a hand which is connected to a stump, and feel able to move it, but of the rest of the limb they are unconscious, and the subjective sensations which are so common are always referred to the hand or foot, and rarely to the continuity of the member.”
·         In about one-third of the leg cases, and in one-half of the arm amputations, the patient felt that the foot or hand is nearer to the trunk than the extremity of the limb.
·         The type of pain could be burning, itching, stabbing, or cramping.
·         Missing legs usually felt as though they are hanging straight down, while missing arms felt as though they were bent at the elbow or locked in the last position they were in prior to the operation.
·         Treatment of water dressings on the stump helped with burning sensations in some cases, but most efforts to relieve PLP were ineffectual.
·         Amputee veterans wrote to Mitchell decades after their operations and shared that in their dreams, they had all their limbs perfectly whole.
    
      Return Friday as Jocelyn finishes up her Civil War medical series.

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A former military wife, Jocelyn Green authored, along with contributing writers, the award-winning Faith Deployed: Daily Encouragement for Military Wives and Faith Deployed . . . Again. Jocelyn also co-authored Stories of Faith and Couragefrom the Home Front, which inspired her first novel: Wedded to War. She loves Mexican food, Broadway musicals, Toblerone chocolate bars, the color red, and reading on her patio. Jocelyn lives with her husband Rob and two small children in Cedar Falls, Iowa.

              
       


The Civil War and Prosthetic Limbs: 2/2

Jocelyn has returned for Part II in this series on Civil War medicine and amputees. Check out Part I here.

As an added bonus, Jocelyn has graciously offered to give away a personalized copy of her latest novel, Widow of Gettysburg, to one commentor. To enter, leave a comment on any of her posts over the next three weeks WITH your e-mail address. Must live in the USA. Winner drawn midnight, Saturday, May 11th, 2013 and announced here at Redwood’s on May 12th, 2013.

Jocelyn has also graciously said she’ll send you a signed bookplate if you have any of her novels and would like one. Again, MUST have your e-mail. 

Good Luck!

Jocelyn appeared before at Redwood’s and you can read those posts here and here.

Welcome back, Jocelyn!


Many entrepreneurs who developed artificial limbs were Civil War veteran amputees themselves. In fact, one of the most successful pioneers in prosthetics was Confederate veteran James Edward Hanger, whose amputation in West Virginia was the first recorded amputation of the Civil War. He was 18 years old at the time. Union surgeons discovered him wounded and performed the amputation, giving him a standard issue replacement leg: a solid piece of wood that made walking clunky and difficult. 
Hanger’s adjustments included better hinging and flexing abilities using rust-proof levers and rubber pads. He also used whittled barrel staves to make the limb lighter-weight. He won the Confederate contract to produce limbs, and by 1890, had moved his headquarters to Washington, D.C., and opened satellite offices in four other cities. The company he founded – Hanger, Inc. – remains a key player in prosthetics and orthotics today.
One of James Hanger’s early patents from 1891. Courtesy of Hanger.com.

The Civil War-era commitment to support veterans continues today through programs of the VA and the Defense Advanced Research Projects Agency (DARPA) to ensure ongoing progress in prosthetics design. The war set the prosthetics industry on a course that would ultimately lead to today’s quasi-bionic limbs that look like the real thing and can often perform some tasks even better.

To see just how far we’ve come in the realm of prosthetic limbs, I invite you to take a look at the video below. This is a brief look at the story of Taylor Morris, the fifth quad amputee veteran in the U.S. Army. You will see Taylor, who is from my hometown of Cedar Falls, Iowa, go from the hospital bed shortly after his surgeries, to dancing with his girlfriend again at the end of the video. (Have a Kleenex handy!)



For further reading:
Hasegawa, Guy R. MendingBroken Soldiers: The Union and Confederate Programs to Supply Artificial Limbs. Southern Illinois University Press, 2012.
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A former military wife, Jocelyn Green authored, along with contributing writers, the award-winning Faith Deployed: Daily Encouragement for Military Wives and Faith Deployed . . . Again. Jocelyn also co-authored Stories of Faith and Couragefrom the Home Front, which inspired her first novel: Wedded to War. She loves Mexican food, Broadway musicals, Toblerone chocolate bars, the color red, and reading on her patio. Jocelyn lives with her husband Rob and two small children in Cedar Falls, Iowa.

The Civil War and Prosthetic Limbs: 1/2

I’m so pleased to host author Jocelyn Green again. She’s an amazing woman and author of inspirational fiction surrounding the Civil War.  Jocelyn will be here over the next three weeks sharing wonderful information about her research. Often times, during war, there is a lot of advancement in medical technology which is why I’m giving her so many days.

Plus, I just love her.

As an added bonus, Jocelyn has graciously offered to give away a personalized copy of her latest novel, Widow of Gettysburg, to one commentor. To enter, leave a comment on any of her posts over the next three weeks WITH your e-mail address. Must live in the USA. Winner drawn midnight, Saturday, May 11th, 2013 and announced here at Redwood’s on May 12th, 2013.

Jocelyn has also graciously said she’ll send you a signed bookplate if you have any of her novels and would like one. Again, MUST have your e-mail. 

Good Luck!

Jocelyn appeared before at Redwood’s and you can read those posts here and here.

Welcome back, Jocelyn!


“It is not two years since the sight of a person who had lost one of his lower limbs was an infrequent occurrence. Now, alas! There are few of us who have not a cripple among our friends, if not in our own families. A mechanical art which provided for an occasional and exceptional want has become a great and active branch of industry. War unmakes legs, and human skill must supply their places as it best may.”
~Oliver Wendell Holms, M.D., “The Human Wheel, Its Spokes and Felloes,” 1863
If necessity is the mother of invention, it should come as no surprise that the Civil War, which produced some 45,000 amputee veterans, also prompted major progress in the development and production of artificial limbs. One of the characters in my novel Widow of Gettysburg is the recipient of one of these limbs. Let’s take a closer look at what was involved in this rehabilitation of amputee veterans. (You can see more on amputations from a previous blog I wrote for Jordyn, here: http://jordynredwood.blogspot.com/2012/08/civil-war-amputations-and-anesthesia_31.html
Double Amputees of the Civil War
Once the stump was healed after amputation and the patient able to do without dressings, the surgeons’ work was finished, and the patient was left to shift for himself in securing the best apparatus. But not everyone was a good candidate for a prosthetic. If the limb was taken off at the joint, such as the hip or shoulder, there was no stump to which an artificial limb could be attached. The surgeon may have performed the operation too high or too low on the limb for a good fit to be possible. Also, if the stump was prone to frequent infection, it would have been too painful to attach an artificial limb to it.
For those who could pursue a prosthetic, in the North, the most popular artificial leg was a “Palmer” leg, named for Benjamin Franklin Palmer, who patented the design. A previous design by James Potts was made of wood, leather, and cat-gut tendons hinging the knee and ankle joints, and dubbed “The Clapper” for the clicking sound of its motion. Palmer improved upon this design with a heel spring in 1846, and his “American leg” was produced continuously through World War 1.
Palmer’s leg cost about $150, a prohibitive amount for the average private, whose pay was about $13 per month. Add to that the cost of travel and lodging expenses to see a specialist, and the number of amputees who could afford it went down even further. The cost of an artificial limb for Confederate veterans was between $300-$500, due to the soaring inflation.
Since the majority of veterans had been farmers, planters, or skilled laborers before the war, the need for artificial limbs was, indeed, a crippling problem. To help address it, the U.S. government appropriated $15,000 in 1862 to pay for limbs for maimed soldiers and sailors. In January 1864, a civilian association in Richmond was established to pay for artificial limbs for Confederate amputees.
After the war in 1866, North Carolina became the first state to start a program for thousands
of amputees to receive artificial limbs. The program offered veterans free accommodations and transportation by rail; 1,550 veterans contacted the program by mail. During the same year, the State of Mississippi spent more than half its yearly budget providing veterans with artificial limbs.
 Return for Part II on Friday.
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 A former military wife, Jocelyn Green authored, along with contributing writers, the award-winning Faith Deployed: Daily Encouragement for Military Wives and Faith Deployed . . . Again. Jocelyn also co-authored Stories of Faith and Couragefrom the Home Front, which inspired her first novel: Wedded to War. She loves Mexican food, Broadway musicals, Toblerone chocolate bars, the color red, and reading on her patio. Jocelyn lives with her husband Rob and two small children in Cedar Falls, Iowa.